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49 years-old ladyPast medical historyHodgkin disease : radiotherapy + chemotherapy in 1993Cardiovascular risk factors: noneSymptoms: PalpitationsShortness of breath (NYHA II)First visit (outpatient clinic) in November 20083/6 systolic murmurECG: Sinus rhythm, left bundle block branch Transthoracic echocardiography Severe mitral regurgitationSystolic pulmonary artery pressure: 50 mm hg
Calcifications of the aortic-mitral aponevrosis highly suggestive of post-radiation valvular heart disease
Post-radiation moderate organic mitral regurgitation - Moderate left enlargement - Normal systolic pulmonary artery pressure
NothingTransesophageal echocardiographyExercise echocardiographyOther ?
Severe mitral regurgitation with complete lack of coaptation
Almost disappearance of the mitral regurgitation
Beginning of the examination
few minutes later
Under beta-blocker therapy60 W, 82% maximal predicted heart rateStop because of fatigueNo change in left ventricular ejection fractionNo change in the degree and mechanism of mitral regurgitationSystolic pulmonary artery pressure: progressive raise from 30 to 60 mm Hg
At 5 years, our patient remains moderately symptomatic and never experienced any acute complication such as pulmonary edema
We are collecting similar cases. If you are interested in participating please contact us Notes to editorDavid Messika-Zeitoun MD, PhD and Claire Cimadevilla MDBichat Hospital, Paris, France