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Flail mitral valve resulting in multiorgan failure

Session Poster Session 4

Speaker Petros Fountoulakis

Event : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : P Fountoulakis (Athens,GR), E Hamodraka (Athens,GR), A Siama (Athens,GR), A Tsoukas (Athens,GR), AJ Manolis (Athens,GR)

P Fountoulakis1 , E Hamodraka1 , A Siama1 , A Tsoukas1 , AJ Manolis1 , 1Asclepeion Voulas Hospital - Athens - Greece ,


Introduction: Mitral valve prolapse is a common echocardiographic finding affecting approximately 2,4 % of the general population and is usually asymptomatic accompanied by mild to moderate valve regurgitation. However in rare cases myxomatous degeneration can lead to severe valve regurgitation either chronically or acutely secondary to superimposed chordae tendinae rupture requiring urgent cardiothoracic management.
Case presentation: ? 66 year old woman was admitted to the Emergency Department of our Hospital due to progressive paroxysmal nocturnal dyspnea and orthopnea. Her personal history included known moderate mitral regurgitation, chronic atrial fibrillation, chronic obstructive pulmonary disease under oxygen therapy, arterial hypertension and dyslipidemia.  Ausculation revealed a third cardiac tone, an holosystolic murmur irradiating to the base of the heart and crackles on both pulmonary bases. The electrocardiogram depicted atrial fibrillation with increased ventricular response. Chest X-ray highlighted right moderate pleural effusion and signs of pulmonary congestion. Transthoracic echocardiography was performed and demonstrated a mitral valve with myxomatous degeneration and a flail posterior cusp accompanied by severe mitral regurgitation with an eccentric jet directed posteriorly and mild left atrial dilatation. The left ventricle manifested hyperdynamic contractibility and pulmonary pressures were only mildly elevated. Coronary angiography followed that depicted an atheromatous coronary network with non-obstructive lesions. In the following hours, the patient became hemodynamically unstable with tissue hypoxia and progressive deterioration of her renal function requiring immediate support with inotrope and vasoconstrictive agents as well as placement of an intraaortic ballon counterpulsation pump. The patient was subsequently transferred to a specialized cardiothoracic center, where she underwent successful valvuloplasty of the mitral valve. However, her general clinical status has deteriorated, thus leading to lethal multiorgan failure.
Conclusion/Discussion:  Cases of myxomatous mitral valve degenaration and proptosis, even if the regurgitation is mild or moderate initially, can acuterly worsen due to chordae tendinae rupture. Acute severe mitral regurgitation imposed on chronic disease is a medical emergency with high morbidity and mortality leading to multiorgan failure and non-reversible cardiogenic shock.

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