Kosin Med J.  2020 Jun;35(1):47-51. 10.7180/kmj.2020.35.1.47.

Dynamic Change of Ischemic Mitral Regurgitation in a Patient with Acute Coronary Syndrome

• Kim HR
• Kang MG
• Kim K
• Park HW
• Hwang JY
• Park JR

• KMID: 2503728
• DOI: http://doi.org/10.7180/kmj.2020.35.1.47

Abstract

Ischemic mitral regurgitation (IMR) is commonly known as a chronic complication of left ventricular remodeling due to coronary artery disease. Acute IMR after coronary artery disease, such as acute myocardial infarction particular, could also develop as a mechanical complication involving papillary muscle rupture. However, the clinical significance of acute transient IMR and the therapeutic intervention in coronary artery disease is infrequently reported. We describe a patient with acute pulmonary edema due to acute IMR, which resolved immediately after coronary revascularization.

Keyword

Acute coronary syndrome; Mitral valve regurgitation; Pulmonary edema

Figure

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  Fig. 1 Initial electrocardiogram shows extensive ST segment elevation on precordial leads.

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  Fig. 2 Coronary angiography revealed about 70% stenosis of the distal right coronary artery (arrow, A) and near total occlusion on proximal left anterior descending artery (arrow, B). LAD, left anterior descending artery; LCX, left circumflex artery.

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  Fig. 3 Transthoracic echocardiograms show dynamic change of mitral regurgitation. Mitral leaflets do not coaptation on end-systole (arrows at parasternal long axis view and apical four chamber view images on upper panel) and color Doppler image shows severe mitral regurgitation (right, upper panel). On follow-up echocardiograms immediately performed after right coronary artery intervention (lower panel), mitral valvular coaptation and severe mitral regurgitation are completely improved.

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