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Resuscitated Cardiac Arrest: Dynamic Mitral Regurgitation Treated With Transapical Valve Replacement
Giulia Nemola1, Ludovica Massa1, Stefano Buratti2
1Department of Heath Sciences, University of Milan, Milan, Italy.
JACC. Case Reports
|March 28, 2025
Summary
Flash pulmonary edema caused by dynamic mitral regurgitation (MR) can lead to cardiac arrest. Stress echocardiography revealed worsening MR during exercise, prompting valve replacement and preventing recurrence.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- Dynamic mitral regurgitation (MR) can present subtly, leading to severe cardiac events like flash pulmonary edema and cardiac arrest.
- Assessing the functional component of valvular heart disease, especially mitral regurgitation, is crucial for accurate diagnosis and management.
Observation:
- An 83-year-old man presented with dyspnea and cardiac arrest following mild exercise.
- Resting echocardiography showed mild mitral stenosis and moderate organic MR, with normal biventricular function.
- Stress echocardiography revealed acute worsening of MR at low-load exercise, precipitating flash pulmonary edema.
Findings:
- Dynamic MR, exacerbated by exercise, was identified as the cause of flash pulmonary edema and cardiac arrest.
- Transapical valve replacement was successfully performed due to high surgical risk.
- The patient experienced an uneventful recovery with no recurrence of symptoms.
Implications:
- Stress echocardiography is valuable for diagnosing dynamic or functional MR, especially when resting studies are inconclusive.
- Early identification and intervention for dynamic MR can prevent life-threatening cardiac events.
- This case highlights the importance of considering dynamic valvular disease in patients with unexplained cardiac symptoms.
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