Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

A patient presented with symptoms of decompensated heart failure 2 months after percutaneous mitral valve (MV) repair. Echocardiography demonstrated impaired left ventricular function with elevated MV pressure gradients and pulmonary pressures during rapid atrial fibrillation. Heart rate control was...

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Bibliographic Details
Published in:ESC Heart Failure 2018-02, Vol.5 (1), p.193-196
Main Authors: Lavall, Daniel, Scheller, Bruno, Werner, Christian, Buob, Axel, Mahfoud, Felix
Format: Article
Language:English
Subjects:
Aged
Cardiac Surgical Procedures - methods
Cardiovascular disease
Case Report
Case Reports
Dyspnea
Echocardiography
Electrocardiography
Female
Global longitudinal strain
Heart failure
Heart rate
Hemodynamics
Humans
Mitral Valve - diagnostic imaging
Mitral Valve - physiopathology
Mitral Valve - surgery
Mitral Valve Insufficiency - diagnosis
Mitral Valve Insufficiency - physiopathology
Mitral Valve Insufficiency - surgery
Mitral valve pressure gradient
Patients
Percutaneous mitral valve repair
Pulmonary pressures
Stroke Volume - physiology
Ventricular Function, Left - physiology
Ventricular Pressure - physiology
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Summary:A patient presented with symptoms of decompensated heart failure 2 months after percutaneous mitral valve (MV) repair. Echocardiography demonstrated impaired left ventricular function with elevated MV pressure gradients and pulmonary pressures during rapid atrial fibrillation. Heart rate control was achieved by implantation of a biventricular pacemaker with subsequent His‐bundle ablation because atrial fibrillation was refractory to medical treatment. During biventricular pacing at different rates (50–110 b.p.m.), heart rate correlated positively with both MV mean pressure gradient and global longitudinal strain and negatively with stroke volume. MV pressure gradients directly translated into elevated pulmonary pressures. Thus, rate control and biventricular pacing improved cardiac haemodynamics.
ISSN:2055-5822
2055-5822
DOI:10.1002/ehf2.12238