A Case of Transient Mitral Regurgitation: Not Everything Is Always What It Seems

Published:December 01, 2021DOI:https://doi.org/10.1053/j.jvca.2021.11.038
      Mitral regurgitation (MR) is a common form of valvular heart disease that is associated with significant morbidity and mortality. MR can be broadly classified into 2 different categories: primary and secondary MR. Primary MR usually is caused by leaflet abnormalities, whereas secondary MR is a chronic disease secondary to geometric distortion of both the annulus and subvalvular apparatus because of left ventricular remodeling. Without acute changes in loading conditions, myocardial blood flow, or rhythm disturbances, functional MR typically is not transient. In this E-Challenge, the authors show a transient and completely reversible acute and severe form of functional MR with the use of multimodal echocardiography.

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        • Dziadzko V
        • Dziadzo M
        • Medina-Inojosa JR
        • et al.
        Causes and mechanisms of isolated mitral regurgitation in the community: Clinical context and outcome.
        Eur Heart J. 2019; 40: 2194-2202
        • Rossi A
        • Dini FL
        • Faggiano P
        • et al.
        Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy.
        Heart. 2011; 97: 1675-1680
        • Del Forno B
        • De Bonis M
        • Agricola E
        • et al.
        Mitral valve regurgitation: A disease with a wide spectrum of therapeutic options.
        Nat Rev Cardiol. 2020; 17: 807-827
        • Avierinos JF
        • Thuny F
        • Tafanelli L
        • et al.
        Eclipsed mitral regurgitation: A new form of functional mitral regurgitation for an unusual cause of heart failure with normal ejection fraction.
        Cardiology. 2008; 110: 29-34
        • Milleron O
        • Bouleti C
        • Mazouz S
        • et al.
        Eclipsed mitral regurgitation: An unusual cause of acute heart failure.
        Eur Heart J Cardiovasc Imaging. 2017; 18: 1163-1169
        • Jain Ch
        • Egbe A
        • Borlaug B.
        Every now and then I fall apart. Total eclipse of the mitral valve.
        Circ Heart Failure. 2020; 13e007145
        • Ichikawa K
        • Watanabe A
        • Ito H.
        Eclipsed mitral regurgitation successfully treated with a combination of surgical and pharmacological therapies: A case report.
        Eur Heart J Case Rep. 2019; 3: ytz039
        • Labbe V
        • Charlier P
        • Brochet E
        • et al.
        Transient severe reversible functional mitral regurgitation: A three-dimensional transoesophageal perspective.
        Eur J Echocardiogr. 2010; 11: E3
        • Kimura M
        • Kohno T
        • Murata M
        • et al.
        Oral nitrate administration ameliorates cardiogenic shock due to eclipsed mitral regurgitation.
        Cardiology. 2016; 134: 327-330