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Severe mitral regurgitation causing unilateral pulmonary edema: A case report.

ABSTRACT: This is a case of a 70-year-old male patient with a history of degenerative mitral valve disease who presented to the emergency department with progressively worsening dyspnea. Prominent findings were rapid atrial fibrillation and unilateral pulmonary edema. Transthoracic and transesophageal echocardiography revealed chordal rupture-related severe-eccentric mitral regurgitation. The patient underwent surgical mitral valve repair.

Learning objectives

•To acknowledge that the clinical presentation may not be as dramatic when acute mitral regurgitation (MR) is superimposed on chronic MR, due to the increased left atrium compliance•To bear in mind that eccentric jets of severe MR can cause unilateral pulmonary infiltrates, mimicking a primary pulmonary process•To remind that rapid atrial fibrillation might be the result rather than the cause of acute cardiac decompensation.

SUBMITTER: Bekiaridou A

PROVIDER: S-EPMC9352419 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Severe mitral regurgitation causing unilateral pulmonary edema: A case report.

Bekiaridou Alexandra A Kartas Anastasios A Moysidis Dimitrios V DV Papazoglou Andreas S AS Patsiou Vasiliki V Baroutidou Amalia A Kamperidis Vasileios V Giannakoulas George G

Journal of cardiology cases 20220422 2

This is a case of a 70-year-old male patient with a history of degenerative mitral valve disease who presented to the emergency department with progressively worsening dyspnea. Prominent findings were rapid atrial fibrillation and unilateral pulmonary edema. Transthoracic and transesophageal echocardiography revealed chordal rupture-related severe-eccentric mitral regurgitation. The patient underwent surgical mitral valve repair.<h4>Learning objectives</h4>•To acknowledge that the clinical prese ...[more]

PMID: 35949571

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Unilateral Pulmonary Edema in Patients With Acute Mitral Regurgitation Caused by Chordal Rupture.

Project description:Background: Cardiogenic unilateral pulmonary edema (UPE) has been reported as an unusual condition and to occur in association with severe mitral regurgitation (MR). However, the prevalence of UPE in patients with severe MR remains unknown. Methods and Results: Among 143 consecutive patients with chordal rupture and significant MR, 38 patients with acute severe MR were studied. The prevalence of UPE was 50% (19 patients); all these patients had right-sided UPE. Eight (21%) patients had bilateral pulmonary edema (BPE). All 8 patients with BPE and 18 of 19 patients with UPE had chordal rupture of the posterior leaflet. All patients with UPE and BPE had severe MR with similar left atrial size. Chest radiographs taken ≤48 h from symptom onset diagnosed UPE in 15 of 19 (79%) patients and BPE in 3 of 8 (38%) patients (P=0.037). Chest radiographs taken >48 h from symptom onset diagnosed UPE in 4 (21%) patients and BPE in 5 (62%) patients (P=0.037). Conclusions: The prevalence of UPE was estimated as 50%; it was most frequently right sided and almost always associated with chordal rupture of the posterior leaflet. UPE is not rare, but common, particularly shortly after the development of acute severe MR caused by chordal rupture.

| S-EPMC9726524 | biostudies-literature

Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation: a case report.

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| S-EPMC8669564 | biostudies-literature

A rare case of left dominant pulmonary edema in acute mitral regurgitation.

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Project description:We reported a case of pericardial agenesis discovered at the age of 60 during coronary artery bypass grafting surgery. However, this anomaly was not treated during the initial surgery. During the post-operatory period, the patient developed recurrent unilateral right pulmonary edema whenever assuming a semi-upright position. We hypothesized that the positional hemodynamic alterations in this patient were related to this rare congenital anomaly. The patient underwent reoperation, 48 hours later, with synthetic pericardial reconstruction and experienced an uneventful recovery during follow-up.

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Congenital double mitral orifice with severe mitral regurgitation-associated rheumatoid arthritis: a case report.

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| S-EPMC7501888 | biostudies-literature

Acute Mitral Regurgitation with Unilateral Left-Sided Pulmonary Edema: A Complication of STEMI Treated Successfully with a MitraClip Procedure

Project description:ABSTRACT A 67-year-old man with inferior wall ST-segment elevation myocardial infarction underwent Impella-assisted percutaneous coronary intervention complicated by unilateral left-sided pulmonary edema and cardiogenic shock due to severe mitral valve regurgitation. Surgery was deferred due to hemodynamic instability and a high risk of mortality, so he underwent a MitraClip procedure. Mitral regurgitation (MR) is a catastrophic mechanical complication of myocardial infarction that leads to the development of pulmonary edema, cardiogenic shock, and death. After the procedure, the patient significantly reduces MR with a resolution of pulmonary edema. Acute MR can rarely present as a unilateral left-sided pulmonary edema delaying diagnosis and treatment. Transcatheter edge-to-edge repair can be a safe alternative for patients who are at high risk for surgery.

| S-EPMC10424758 | biostudies-literature

Severe noncardiogenic pulmonary edema after cardiopulmonary bypass: Case report.

Project description:Lung injury is a common complication after cardiopulmonary bypass (CPB). However, cases of noncardiogenic pulmonary edema in which the patient ultimately requires extracorporeal membrane oxygenation (ECMO) support are uncommon. A 54-year-old man was admitted to the hospital with shortness of breath after activity and paroxysmal dyspnoea at night for 3 months. Infective endocarditis and acute heart failure were diagnosed. The patient underwent emergency surgery including aortic valve replacement, mitral valve replacement, tricuspid valve repair, and ventricular septal defect correction. It's noteworthy that the patient experienced significant pulmonary edema during the surgery and within 8 hours postoperatively, with over 3000 mL of yellow-clear fluid aspirated from the trachea and bronchi. The patient eventually recovered through ECMO V-V mode treatment. Inflammatory markers were markedly elevated during the perioperative period, and blood smear revealed Gram-positive bacterial infection. Blood NGS testing detected Streptococcus pneumoniae infection. Despite various factors contributing to the patient's pulmonary edema, it is hypothesized that the edema is related to uncontrolled inflammatory response and cytokine storm. Therefore, when significant pulmonary edema occurs during surgery, swift and decisive actions are necessary to avoid missing the optimal rescue window. If required, the use of ECMO is an effective final treatment option.

| S-EPMC10589860 | biostudies-literature

Redo MitraClip for Late Recurrent Severe Mitral Regurgitation: Case Report and Literature Review.

Project description:Transcatheter mitral valve repair using the MitraClip (Abbott Vascular, Santa Clara, CA) is a reasonable option for the treatment of patients with severe symptomatic degenerative mitral regurgitation (MR) who are at prohibitive surgical risk. The occurrence of recurrent severe MR after initial successful MitraClip repair is uncommon. Data are sparse on the management of recurrent severe MR after initial successful repair using the MitraClip. We describe a successful case of redo MitraClip repair for late recurrent severe MR secondary to progressive degenerative mitral valve disease after a successful initial MitraClip procedure and review the literature.

| S-EPMC7242512 | biostudies-literature

Severe mitral regurgitation from Libman-Sacks endocarditis treated with MitraClip: a case report.

Project description:BackgroundSystemic lupus erythematosus (SLE) valvulopathy can manifest as a spectrum of pathologies and treatment of severe valvular dysfunction thus far has been surgical. However, surgery in patients with SLE is frequently associated with high morbidity and mortality due to the presence of significant co-morbidities.Case summaryWe report the case of a 41-year-old woman with SLE and anti-phospholipid syndrome with extensive co-morbidities including lupus nephritis, pancytopaenia, cerebrovascular accident, and severe airway obstruction from ipsilateral lung collapse and bronchiectasis. She had severe mitral regurgitation (MR) from Libman-Sacks endocarditis and in recent months developed heart failure with progressive exertional dyspnoea from New York Heart Association (NYHA) functional Class from New York Heart Association (NYHA) functional class II to III. In addition, there was progressive left ventricular dilatation and reduction in left ventricular ejection fraction. In view of the high surgical risk, she underwent transcatheter edge-to-edge repair (TEER) of the mitral valve with the MitraClip system. At 1-month follow-up, she was back to NYHA functional Class II with mild MR.DiscussionOur case demonstrates that in select patient with suitable anatomy, TEER is a potential treatment option for severe MR from SLE valvulopathy.

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