Eclipsed mitral regurgitation: an unusual cause of acute heart failure.
OBJECTIVE
So far, a total of five patients with eclipsed mitral regurgitation (MR) have been reported in the literature by three different teams. The aim of this article was to detail clinical and echocardiographic characteristics, and outcome of patients presenting eclipsed MR.


RESULTS
We defined eclipsed MR as spontaneous appearance, at rest, from 1 min to the next of an acute restriction in the motion of mitral leaflets preventing coaptation and leading to massive MR in patients with normal left ventricular end-diastolic diameter, left ventricular ejection fraction >45%, and baseline MR ≤2. Spontaneous regression occurred within 30 min, and no obvious trigger such as acute hypertension, new-onset arrhythmia, or myocardial ischaemia is present. Clinical data, ECG, echocardiographic data, surgery report, and follow-up status of six patients with eclipsed MR are reported: all were post-menopausal women with median age of 74 [57-80] years presenting hypertension (4/6), chronic kidney disease (5/6), or chronic anaemia (4/6). Five out of six patients experienced acute pulmonary oedema requiring hospitalization and underwent mitral valve replacement because of heart failure recurrence. Two patients died in the first days after surgery while the three others are free of symptoms at, respectively, 56, 18, and 10 months follow-up.


CONCLUSIONS
Eclipsed MR is a clinical and echocardiographic syndrome responsible for heart failure with preserved EF. It is presently underdiagnosed and should be evoked in cases of recurrent acute pulmonary oedema without obvious trigger, in particular in patients presenting discordant evaluation of MR severity over time.
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France.|DHU Fire, Paris-Diderot University, Paris, France.
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Milleron
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France.|DHU Fire, Paris-Diderot University, Paris, France.
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Bouleti
Department of Cardiology, Montfermeil Hospital, Paris, France.
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Mazouz
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France.|DHU Fire, Paris-Diderot University, Paris, France.
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Brochet
Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.|INSERM U1148 Bichat Hospital, Paris, France.|Faculté de Médecine Paris-Diderot University, Paris, France.
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Rouzet
DHU Fire, Paris-Diderot University, Paris, France.|Faculté de Médecine Paris-Diderot University, Paris, France.|Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
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Nataf
DHU Fire, Paris-Diderot University, Paris, France.|Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
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Ghodbane
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France.|DHU Fire, Paris-Diderot University, Paris, France.|INSERM U1148 Bichat Hospital, Paris, France.|Faculté de Médecine Paris-Diderot University, Paris, France.
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Messika-Zeitoun
Department of Anaesthesiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
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Dilly
Department of Cardiology, Montfermeil Hospital, Paris, France.
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Cattan
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France.|DHU Fire, Paris-Diderot University, Paris, France.|INSERM U1148 Bichat Hospital, Paris, France.|Faculté de Médecine Paris-Diderot University, Paris, France.
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Vahanian
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France.|DHU Fire, Paris-Diderot University, Paris, France.|INSERM U1148 Bichat Hospital, Paris, France.|Faculté de Médecine Paris-Diderot University, Paris, France.
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Iung
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France.|DHU Fire, Paris-Diderot University, Paris, France.|INSERM U1148 Bichat Hospital, Paris, France.|Faculté de Médecine Paris-Diderot University, Paris, France.
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Jondeau
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000379:methods; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D011379:Prognosis; D035583:Rare Diseases; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D015996:Survival Rate
acute mitral regurgitation; echocardiography; eclipsed mitral regurgitation; functional mitral regurgitation; heart failure with preserved LVEF; transient acute mitral regurgitation