Reversible severe ischemic mitral regurgitation and cardiogenic shock as a complication of percutaneous coronary...

We describe a case of severe ischemic mitral regurgitation (MR) causing reversible cardiogenic shock as a complication of percutaneous coronary intervention (PCI) of the circumflex due to no-reflow. Baseline echocardiography before PCI showed only mild MR. After the occurrence of no-reflow post stenting, patient developed acute hypotension, hypoxia, pulmonary edema, increase in pulmonary mean wedge pressure to 42 mmHg with very high V-wave during pulmonary wedge tracing and cardiogenic shock requiring intra-aortic balloon pump (IABP) insertion. Urgent echocardiography revealed severe MR. With the establishment of normal flow in the circumflex artery after IABP insertion and intracoronary adenosine injections, severe MR, hypoxia and all hemodynamic instability resolved. We present this case as a first documented complication of PCI causing severe reversible ischemic MR leading to cardiogenic shock and a review of the literature. We conclude that in all patients with sudden unexplained hemodynamic deterioration during PCI, an urgent echocardiogram is indicated to recognize possible acute ischemic MR.