Mitral regurgitation chest x-ray
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
The chest x-ray in individuals with chronic mitral regurgitation is characterized by the presence of an enlargement of the left atrium and the left ventricle. In acute mitral regurgitation, pulmonary edema is present and the heart is not enlarged.
Chest X Ray
- The pulmonary vascular markings are typically normal in chronic compensated mitral regurgitation, since the pulmonary venous pressures are usually not significantly elevated.
- Calcification of the mitral annulus is not infrequent, and is seen in up to 35% of elderly patients on echocardiography which is more sensitive than CXR. It typically begins around the margins of the posterior leaflet forming a “C” (as in this case) - eventually with anterior leaflet involvement the “C” closes forming an “O”.
- As opposed to aortic valve calcification, calcification of the mitral annulus is not significantly associated with stenosis of the valve and contrary to previous thought, nor is it associated with strokes - when other factors are adjusted for in multivariate models.
- Mitral valve calcification can be associated with impaired AV nodal conduction and can be associated with varying degrees of heart block.
- The left main sten bronchus can be pushed up by an enlarged left atrium
- Pathologically it is important to distinguish annular calcification, which is not on the leaflet, and is covered with intact endothelium, from leaflet calcification in stenotic valves secondary to rheumatic fever.
- If there is no enlargement of the cardiac silhouette and pulmonary edema is present, this suggests acute disruption of the valve apparatus.