超声心动图实用手册Practical Manual of Echocardiography_部分28.pdf

230 | Chapter 16 (a) (b) Figure 16.4 (a) A dissection lap (asterisk) is noted in the ascending aorta with malcoaptation of the aortic lealeats (arrow). (b) Severe aortic regurgitation is noted on color doppler in this patient (Reproduced from Fernandez-Jimenez et al. [7], with permisison from Elsevier). Posteriomedial papillary muscle, which is supplied by the right coronary artery, is more frequently involved as compared to the anterolateral one, which has dual blood supply: left circumflex and the left anterior descending. Evaluation of a new heart murmur | 231 Since both the anterior and posterior leaflets are supported by the  posterior papillary muscle, inferior infarction can result in regurgitation through any of the mitral valve leaflets. Acute MR due to trauma: Blunt chest trauma → Increased intracardiac pressure against closed mitral valve → Posterior leaflet tear from mitral annulus or annular dehiscence → Eccentric mitral regurgitation jet. Normal left ventricular size with either normal or hyperdynamic function should raise suspicion for the regurgitation to be acute in onset. Since the left-sided chambers have not had time to adapt to the acute MR, pulmonary edema, shock and/or biventricular failure develops. Acute AR due to aortic dissection (Figure 16.4): In aortic dissection, acute AR results from annular or aortic root dilatation leading to incomplete coaptation of the valve leaflets or extension of the dissection into the valve itself. Due to the acuity of the situation, the left ventricle has no time to adapt to the volume overload leading to increase in the