Recurrent severe mitral regurgitation due to left ventricular apical wall motion abnormality caused by coronary vasospastic angina: a case report.
A 76-year-old man developed congestive heart failure due to severe mitral regurgitation after episodes of vasospastic angina. Echocardiography demonstrated left ventricular apical akinesis with ballooning and deformity of the anterior mitral leaflet becoming concave toward the left atrium. The acetylcholine provocation test induced diffuse coronary vasospasm in the distal segments of both right and left coronary arteries and reproduced severe mitral regurgitation. Follow-up echocardiography demonstrated decreased mitral regurgitation with ameliorated apical wall motion. Coronary vasospasm remained refractory to antivasospastic medications and severe mitral regurgitation relapsed 1 month after discharge. Mitral valve annuloplasty with a Carpentier-Edwards physio ring was performed, and no recurrence of mitral regurgitation was observed despite some episodes of vasospastic angina. We speculate that vasospastic angina and the resultant apical wall motion abnormality caused tethering of the mitral subvalvular apparatus, leading to inappropriate mitral coaptation and severe regurgitation.
Shimizu
Masatoshi
M
Department of Cardiology, National Hospital Organization Kobe Medical Center, Nishiochiai 3-1-1, Suma-ku, Kobe 654-0155.
Kato
Yukio
Y
Matsukawa
Ritsu
R
Masai
Hiroyuki
H
Shima
Takashi
T
Miwa
Yoichi
Y
Yamashita
Teruo
T
Okita
Yutaka
Y
D000368:Aged; D000788:Angina Pectoris, Variant / Q000150:complications* / Q000503:physiopathology; D003329:Coronary Vasospasm / Q000150:complications* / Q000503:physiopathology; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D009200:Myocardial Contraction; D012008:Recurrence; D012720:Severity of Illness Index; D014463:Ultrasonography