Eclipsed mitral regurgitation: A new form of functional mitral regurgitation for an unusual cause of heart failure with normal ejection fraction

Jean François Avierinos, Franck Thuny, Laurence Tafanelli, Sebastien Renard, Virginie Chalvignac, Eric Guedj, Marc Lambert, Jacques Quilici, Jean Louis Bonnet, Maurice Enriquez-Sarano, Gilbert Habib

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background: Transient functional mitral regurgitation (MR) has never been reported as a cause of heart failure (HF) with normal ejection fraction (EF) in the absence of epicardial coronary artery stenosis. Results: Performance of echocardiography in patients with acute HF before initiation of HF medical treatment allowed identification of three patients with normal EF but transient massive functional MR during the HF episode. In all patients, massive MR occurred as a consequence of sudden extreme apical tenting of both leaflets with total lack of coaptation, despite normal EF and absence of detectable left ventricular (LV) remodeling, and despite absence of significant stenosis on coronary arteries. In all patients MR was triggered by methylergonovine injection and was reversible either spontaneously or after nitroglycerine administration, leaving patients with normal echocardiogram between HF episodes. In two patients, long-term administration of calcium channel blockers prevented recurrences of MR and HF, whereas in one, mitral valve was eventually replaced. Conclusion: Sudden reversible apical tenting of mitral leaflets with subsequent torrential MR and acute HF can occur despite normal EF, absence of pre-existing LV remodeling and absence of coronary artery stenosis. This atypical type of functional MR is an unusual mechanism of HF in patients with normal LVEF.

Original languageEnglish (US)
Pages (from-to)29-34
Number of pages6
JournalCardiology
Volume110
Issue number1
DOIs
StatePublished - Apr 1 2008

Keywords

  • Echocardiography
  • Functional mitral regurgitation
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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    Avierinos, J. F., Thuny, F., Tafanelli, L., Renard, S., Chalvignac, V., Guedj, E., Lambert, M., Quilici, J., Bonnet, J. L., Enriquez-Sarano, M., & Habib, G. (2008). Eclipsed mitral regurgitation: A new form of functional mitral regurgitation for an unusual cause of heart failure with normal ejection fraction. Cardiology, 110(1), 29-34. https://doi.org/10.1159/000109403