Authors

• Siniša Roginić — Zabok General Hospital, Zabok, Croatia — ORCID: 0000-0002-0384-8088
• Jelena Zajec Gorički — Zabok General Hospital, Zabok, Croatia — ORCID: 0000-0002-7625-6905
• Marija Čajko — Zabok General Hospital, Zabok, Croatia — ORCID: 0000-0001-7084-707X
• Krešimir Štambuk — Clinic for Cardiovascular Diseases Magdalena, Krapinske Toplice, Croatia — ORCID: 0000-0002-9107-6187

Abstract

**Introduction**: Secondary mitral regurgitation (MR) is a dynamic myocardial disease accompanying cardiomyopathy and coronary artery disease. (1-4) **Case report**: We present a case of 63-year-old patient with long standing cardiomyopathy after breast cancer chemotherapy. Her left ventricle (LV) is slightly dilated with moderately impaired systolic function (estimated EF 30%) and severe diastolic disfunction. Significant MR (**Figure 1**, **Figure 2**) has been present for years but patient’s condition deteriorated rapidly with frequent admissions for heart failure despite optimal medical therapy. Upon last discharge echocardiography showed slight improvement in LV systolic function and persistent severe secondary MR. She has no significant coronary artery disease or indication for CRT. FIGURE 1. Parasternal long axis view showing dilated left ventricle and significant mitral regurgitation into dilated left atrium. FIGURE 2. Mitral quantification using the proximal isovelocity surface area (PISA) method – effective regurgitant orifice area (EROA) 0.5 cm2, right ventricle (RV) 57 ml. **Discussion and Conclusion**: Severe secondary MR is in most cases treated conservatively, especially in the absence of other surgical indication. According to guidelines mitral valve intervention (surgery or transcatheter procedure) may be considered in refractory cases after heart team discussion. Our patient was subsequently scheduled for mitral valve replacement.

Keywords

mitral regurgitation, cardiomyopathy, mitral valve surgery

DOI

Literature

1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017 Jul 11;70(2):252–89. https://doi.org/10.1016/j.jacc.2017.03.011
2. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017 Sep 21;38(36):2739–91. https://doi.org/10.1093/eurheartj/ehx391
3. Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. COAPT Investigators. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018 Dec 13;379(24):2307–18. https://doi.org/10.1056/NEJMoa1806640
4. Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, et al. MITRA-FR Investigators. Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. N Engl J Med. 2018 Dec 13;379(24):2297–306. https://doi.org/10.1056/NEJMoa1805374