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An unusual-mitral-regurgitation
 

An unusual-mitral-regurgitation

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    An unusual-mitral-regurgitation An unusual-mitral-regurgitation Presentation Transcript

    • An Unusual Mitral Regurgitation David Messika-Zeitoun MD, PhD and Claire Cimadevilla MD Bichat Hospital, Paris, France
    • Medical History • 49 years-old lady • Past medical history • Hodgkin disease : radiotherapy + chemotherapy in 1993 • Cardiovascular risk factors: none • Symptoms: • Palpitations • Shortness of breath (NYHA II)
    • Medical History • First visit (outpatient clinic) in November 2008 • 3/6 systolic murmur • ECG: Sinus rhythm, left bundle block branch • Transthoracic echocardiography • • Severe mitral regurgitation Systolic pulmonary artery pressure: 50 mm hg
    • Transthoracic Echocardiography a few days after Watch video Watch video Watch video Watch video
    • Etiology Calcifications of the aortic-mitral aponevrosis highly suggestive of post-radiation valvular heart disease Hering American Journal of Cardiology 2003
    • Quantification: Vena Contracta 3 mm Mild MR Gray zone 7 mm Severe MR
    • Quantification: PISA Aliasing velocity (Va) R ERO = 0.17 cm² RVOL = 37 ml
    • TTE Conclusions - Post-radiation moderate organic mitral regurgitation - Moderate left enlargement - Normal systolic pulmonary artery pressure
    • What to do next to explain discrepancies between outpatient and inpatient echocardiographies • Nothing • Transesophageal echocardiography • Exercise echocardiography • Other ?
    • What to do next to explain discrepancies between outpatient and inpatient echocardiographies • Nothing • Transesophageal echocardiography • Exercise echocardiography • Other ?
    • Transesophageal Echocardiography: beginning of the examination Watch video Watch video Watch video Severe mitral regurgitation with complete lack of coaptation
    • Transesophageal Echocardiography: Few minutes later Watch video Watch video Almost disappearance of the mitral regurgitation
    • 3D Transesophageal Echocardiography Beginning of the examination Watch video Few minutes later Watch video 3D TEE nicely showing the conformational changes of the aortic annulus and absence of leaflet coaptation
    • Diagnosis Severe MR Paroxysmal Functional called “eclipsed MR”
    • Coronary Angiography Watch video Watch video Normal coronary angiography
    • Exercise Echocardiography Under beta-blocker therapy 60 W, 82% maximal predicted heart rate Stop because of fatigue No change in left ventricular ejection fraction • No change in the degree and mechanism of mitral regurgitation • Systolic pulmonary artery pressure: progressive raise from 30 to 60 mm Hg • • • •
    • At 5 years, our patient remains moderately symptomatic and never experienced any acute complication such as pulmonary edema We are collecting similar cases. If you are interested in participating please contact us david.messika-zeitoun@bch.aphp.fr
    • Join the ESC Working Group on Valvular Heart Disease and take part in its activities ! Membership is FREE!