Angiographic features of rheumatic and nonrheumatic mitral regurgitation.

Left ventricular cineangiography was performed in 37 patients with mitral regurgitation. Twenty-one patients had rheumatic mitral valve disease determined by careful surgical and pathologic examination, 10 had papillary muscle dysfunction, and six had chordae tendineae rupture. Fourteen of the 16 patients considered to have nonrheumatic mitral regurgitation were confirmed surgically; the other two patients developed mitral regurgitation acutely following myocardial infarction. Cineangiograms were evaluated for valve calcification, appearance and mobility of mitral valve leaflets, character of the regurgitant jet, and ventricular contractility. By these criteria, rheumatic mitral regurgitation was distinguished from papillary muscle dysfunction and chordae tendineae rupture in every case. A correct diagnosis of papillary muscle dysfunction was made when focal areas of myocardial dysfunction, determined by comparing tracings of end-systolic and end-diastolic cine frames, occurred at the base of the papillary muscle. However, half the cases of papillary muscle dysfunction had apparently normal contractility. The involved leaflet was correctly identified in the six cases of chordae tendineae rupture.