By Arnold M. Katz (auth.), Wilson S. Colucci MD (eds.)
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Additional info for Atlas of Heart Failure: Cardiac Function and Dysfunction
Adapted from Nishioka et al. • •• • :::J • '; I 100 ® •• • FIGURE 2-19. Formulation of muscle energetics. In 34 studies carried out in 23 dogs with various degrees of aortic obstruction, Britman and Levine  measured cardiac output, left ventricular (LV) and aortic pressures, heart rate, LV volume, coronary sinus blood flow, and coronary sinus oxygen extraction. They then compared LV oxygen consumption (LVq02) in mL/min/100 g of LV mass with contractile element work per minute in dynes•cm/min/100 g of LV weight.
Also shown is a specimen from a patient with massive eccentric hypertrophy due to chronic aortic regurgitation secondary to healed bacterial endocarditis (C). Chronic aortic insufficiency produces the largest enddiastolic volumes of any heart condition, a condition termed cor bovinum. The weight of this specimen exceeded 1000 g. (Courtesy of Frederick J. ) Heart failure associated with mitral regurgitation. When mitral regurgitation is acute, it may produce symptomatic pulmonary edema as well as pulmonary hypertension and right heart failure.
In chronic mitral regurgitation, the ventricle operates at a greater volume and, as with aortic regurgitation, ventricular size has proven to be predictive of impaired postoperative function. B, Echocardiogram with color Doppler depicting severe mitral regurgitation in a 70-year-old woman with a myxomatous mitral valve and a ruptured chordae. The Doppler jet demonstrates the systolic regurgitant flow-velocity from LV to LA (arrow). 9 em). (Part A adapted from Kontos et al. ) FIGURE 3-10. Paradoxically, dilated cardiomyopathy may appear to worsen after mitral valve replacement due to surgical transection of the subvalvular apparatus.