Resuscitated Cardiac Arrest: Dynamic Mitral Regurgitation Treated With Transapical Valve Replacement

Flash pulmonary edema secondary to dynamic mitral regurgitation (MR) may be an uncommon cause of cardiac arrest. We present the case of an 83-year-old man who experienced recurrent acute dyspnea followed by cardiocirculatory arrest on mild exercise. His coronary angiogram was normal. Rest echocardiography demonstrated normal biventricular size and systolic function and mixed mild mitral stenosis with moderate organic regurgitation. During stress echocardiography, he showed acute worsening of MR at low-load exercise and ensuing flash pulmonary edema. Because of the high surgical risk, valve replacement through transapical access was deemed the ideal approach. The patient had an uneventful postoperative course, without recurrence of events. This case depicts the heterogeneous and subtle nature of MR, which may be dynamic or have a functional component superimposed on organic valve disease and may have dramatic consequences. Stress echocardiography should be considered in the diagnostic algorithm of nonsevere valve diseases, especially where there is a mismatch between symptoms and severity.