Key result
Low-risk reconstructive procedures successfully corrected mitral regurgitation without the need for prosthetic valve replacement in 7 patients presenting with a "murmur on top of the head".
Why the study?
The clinical and pathological significance of a "murmur on top of the head" in acquired mitral insufficiency and its surgical implications were not well characterized.
Does reconstructive surgery correct mitral regurgitation in patients presenting with a "murmur on top of the head"?
Case Report (n=7)
Does reconstructive surgery correct mitral regurgitation in patients presenting with a "murmur on top of the head"?
The presence of a "murmur on top of the head" in acquired mitral insufficiency indicates specific correctable pathologies (ruptured chordae or annular dilatation) amenable to low-risk reconstructive surgery rather than valve replacement.
Head murmur may flag flail anterior mitral leaflet from chordal rupture; leaves open specificity and role beyond this Level 5 series.
A "murmur on top of the head" has been documented in seven patients with mitral insufficiency. Five patients revealed ruptured chordae tendineae of anterior leaflets secondary to rheumatic fever or subacute bacterial endocarditis. Two remaining patients exhibited rheumatic valvulitis and annular dilatation. The regurgitation was readily corrected by excising or plicating the flail area or posteromedial annuloplasty, or both. Survivors are asymptomatic without embolization or infection. Whether due to ruptured chordae of the aortic leaflet (usual) or valvulitis and annular dilatation (and in the absence of valvular calcification by fluoroscopy), the problem has been correctable by iow-risk reconstructive procedures without need for prosthetic valve replacement. Therefore, when this murmur is present, valuable inferences regarding etiology, pathology, surgical therapy, and prognosis can be made.
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K. Alvin Merendino (1967) conducted a case report in Acquired mitral insufficiency (n=7). Reconstructive surgical procedures was evaluated on Correction of regurgitation and postoperative symptoms. Low-risk reconstructive procedures successfully corrected mitral regurgitation without the need for prosthetic valve replacement in 7 patients presenting with a "murmur on top of the head".
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