2. 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)
3. 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
8. TTE Conclusions
- Post-radiation moderate
organic mitral regurgitation
- Moderate left enlargement
- Normal systolic pulmonary
artery pressure
9. What to do next to explain discrepancies between
outpatient and inpatient echocardiographies
• Nothing
• Transesophageal echocardiography
• Exercise echocardiography
• Other ?
10. What to do next to explain discrepancies between
outpatient and inpatient echocardiographies
• Nothing
• Transesophageal echocardiography
• Exercise echocardiography
• Other ?
13. 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
16. 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
•
•
•
•
17. 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
18. Join the ESC Working Group
on Valvular Heart Disease
and take part in its
activities !
Membership is FREE!
