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Abnormalities in the Mitral Valve Apparatus in Patients Undergoing Long-term Hemodialysis: Autopsy and Echocardiographic Correlation

Abnormalities in the Mitral Valve Apparatus in Patients Undergoing Long-term Hemodialysis:... Abstract • Examination of the heart at autopsy in patients who received long-term hemodialysis revealed the following two changes in the mitral valve apparatus previously almost completely overlooked: (1) fibrosis and thickening affecting chordae tendineae in four cases: in one, severe mitral regurgitation was documented by hemodynamic studies; (2) extensive calcification in the mitral anulus region in two cases, with calcification in the base of the mitral leaflets in one and in the papillary muscle and chordae tendineae in the other. The causes of these abnormalities is unclear. Rheumatic and other known causes all seem unlikely origins of the extensive fibrosis. Secondary hyperparathyroidism is probably responsible for the calcification. In all six patients, these abnormalities in the mitral valve apparatus, which may be associated with functional impairment, were diagnosed during life by M-mode and two-dimensional echocardiography. (Arch Intern Med 1982;142:1796-1800) References 1. Lowrie EG, Lazarus JM, Hampers CL, et al: Cardiovascular disease in dialysis patients. N Engl J Med 1974;290:737-738.Crossref 2. Linder A, Charra B, Sherrard DJ, et al: Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 1974;290:697-701.Crossref 3. DePace NL, Rohrer AH, Kotler MN, et al: Rapidly progressing, massive mitral annular calcification: Occurrence in a patient with chronic renal failure. Arch Intern Med 1981;141:1663-1665.Crossref 4. Roberts WC, Waller BF: Effect of chronic hypercalcemia on the heart: An analysis of 18 necropsy patients. Am J Med 1981;71:371-384.Crossref 5. Gurland HJ, Brunner FP, Dehn H, et al: Combined report on regular dialysis and transplantation in Europe. Proc Eur Dial Transplant Assoc 1973;10:17. 6. Pomerance A: Chronic rheumatic and other inflammatory valve diseases , in Pomerance A, Davis MJ (eds): Pathology of the Heart . Oxford, England, Blackwell Scientific Publications, 1975, pp 307-326. 7. Spain DM: Association of gastrointestinal carcinoid tumor with cardiovascular abnormalities. Am J Med 1955;19:366-369.Crossref 8. Trent JK, Adelman AG, Wigle ED: Morphology of a prolapsed posterior mitral valve leaflet. Am Heart J 1970;79:539-543.Crossref 9. Berenson GS, Geer JC: Heart disease in the Hurler and Marfan syndromes. Arch Intern Med 1963;111:58-69.Crossref 10. Misch KA: Development of heart valve lesions during methysergide therapy. Br Med J 1974;2:365-366.Crossref 11. Kassirer JP, Gang DL: Hypotension and flank pain in a man with chronic renal failure: Clinico-pathological case report. N Engl J Med 1982;306:975-983.Crossref 12. Goldblum SE, Reed WP: Host defenses and immunologic alterations associated with chronic hemodialysis. Ann Intern Med 1980;93:597-609.Crossref 13. Jain MC, D'Cruz IA, Kathpalia S: Chronic renal failure: Intracardiac calcification. Primary Cardiol 1981;7:121-125. 14. Langendorf R, Pirani CL: The heart in uremia. Am Heart J 1947;33:282-305.Crossref 15. Scotti TM: Heart , in Anderson WAD (ed): Pathology , ed 6. St Louis, CV Mosby Co, 1971, vol 1, pp 589-705. 16. D'Cruz IA, Bhatt GR, Cohen HC, et al: Echocardiographic detection of cardiac involvement in patients with chronic renal failure. Arch Intern Med 1978;138:720-724.Crossref 17. Schott CR, Kotler MN, Wayne RP, et al: Mitral annular calcification: Clinical and echocardiographic correlations. Arch Intern Med 1977;137:1143-1150.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Abnormalities in the Mitral Valve Apparatus in Patients Undergoing Long-term Hemodialysis: Autopsy and Echocardiographic Correlation

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340230036007
Publisher site
See Article on Publisher Site

Abstract

Abstract • Examination of the heart at autopsy in patients who received long-term hemodialysis revealed the following two changes in the mitral valve apparatus previously almost completely overlooked: (1) fibrosis and thickening affecting chordae tendineae in four cases: in one, severe mitral regurgitation was documented by hemodynamic studies; (2) extensive calcification in the mitral anulus region in two cases, with calcification in the base of the mitral leaflets in one and in the papillary muscle and chordae tendineae in the other. The causes of these abnormalities is unclear. Rheumatic and other known causes all seem unlikely origins of the extensive fibrosis. Secondary hyperparathyroidism is probably responsible for the calcification. In all six patients, these abnormalities in the mitral valve apparatus, which may be associated with functional impairment, were diagnosed during life by M-mode and two-dimensional echocardiography. (Arch Intern Med 1982;142:1796-1800) References 1. Lowrie EG, Lazarus JM, Hampers CL, et al: Cardiovascular disease in dialysis patients. N Engl J Med 1974;290:737-738.Crossref 2. Linder A, Charra B, Sherrard DJ, et al: Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 1974;290:697-701.Crossref 3. DePace NL, Rohrer AH, Kotler MN, et al: Rapidly progressing, massive mitral annular calcification: Occurrence in a patient with chronic renal failure. Arch Intern Med 1981;141:1663-1665.Crossref 4. Roberts WC, Waller BF: Effect of chronic hypercalcemia on the heart: An analysis of 18 necropsy patients. Am J Med 1981;71:371-384.Crossref 5. Gurland HJ, Brunner FP, Dehn H, et al: Combined report on regular dialysis and transplantation in Europe. Proc Eur Dial Transplant Assoc 1973;10:17. 6. Pomerance A: Chronic rheumatic and other inflammatory valve diseases , in Pomerance A, Davis MJ (eds): Pathology of the Heart . Oxford, England, Blackwell Scientific Publications, 1975, pp 307-326. 7. Spain DM: Association of gastrointestinal carcinoid tumor with cardiovascular abnormalities. Am J Med 1955;19:366-369.Crossref 8. Trent JK, Adelman AG, Wigle ED: Morphology of a prolapsed posterior mitral valve leaflet. Am Heart J 1970;79:539-543.Crossref 9. Berenson GS, Geer JC: Heart disease in the Hurler and Marfan syndromes. Arch Intern Med 1963;111:58-69.Crossref 10. Misch KA: Development of heart valve lesions during methysergide therapy. Br Med J 1974;2:365-366.Crossref 11. Kassirer JP, Gang DL: Hypotension and flank pain in a man with chronic renal failure: Clinico-pathological case report. N Engl J Med 1982;306:975-983.Crossref 12. Goldblum SE, Reed WP: Host defenses and immunologic alterations associated with chronic hemodialysis. Ann Intern Med 1980;93:597-609.Crossref 13. Jain MC, D'Cruz IA, Kathpalia S: Chronic renal failure: Intracardiac calcification. Primary Cardiol 1981;7:121-125. 14. Langendorf R, Pirani CL: The heart in uremia. Am Heart J 1947;33:282-305.Crossref 15. Scotti TM: Heart , in Anderson WAD (ed): Pathology , ed 6. St Louis, CV Mosby Co, 1971, vol 1, pp 589-705. 16. D'Cruz IA, Bhatt GR, Cohen HC, et al: Echocardiographic detection of cardiac involvement in patients with chronic renal failure. Arch Intern Med 1978;138:720-724.Crossref 17. Schott CR, Kotler MN, Wayne RP, et al: Mitral annular calcification: Clinical and echocardiographic correlations. Arch Intern Med 1977;137:1143-1150.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1982

References