Transient Symptomatic Severe Mitral Regurgitation after Electric Cardioversion of Atrial Fibrillation

Article Article scientifique Rapport de cas Transient Symptomatic Severe Mitral Regurgitation after Electric Cardioversion of Atrial Fibrillation eng 2012-11-27 2013-02 author Stampfli Tomoe Elianne Lybia Division of Cardiology; Geneva University Hospitals; Geneva; Switzerland 88927 author Monnard Simon Division of Cardiology; Geneva University Hospitals; Geneva; Switzerland 717561 author Mueller Hajo 0000-0001-9366-9499 Division of Cardiology; Geneva University Hospitals; Geneva; Switzerland 89204 Département de médecine (DEMED) E36-E38 10.1111/echo.12055 23189998 0742-2822 https://onlinelibrary.wiley.com/doi/10.1111/echo.12055 Introduction: After electric cardioversion (EC), several cases of cardiac stunning with cardiogenic shock have been reported. Several hypotheses have been proposed, including stunning of the left ventricle (LV) and modifications in the LV conformation that could lead to severe mitral regurgitation (MR). We report 2 cases of cardiogenic shock with severe MR after EC for atrial fibrillation (AF). Case 1: A 75-year-old man presented with AF. A transesophageal echocardiography before the EC showed moderate MR. Shortly after successful EC, the patient developed a cardiogenic shock. The transthoracic and a transesophageal echocardiography showed severe MR. Four days later, an echocardiography showed recovery of MR to a moderate grade. Case 2: An 85-year-old woman with a history of percutaneous aortic valve replacement presented with AF. After EC, she developed a cardiogenic shock. The transthoracic echocardiography showed severe MR. After recovery, the echocardiography showed moderate MR. Discussion: Cardiac stunning after EC is well known and could explain the development of severe MR due to restrictive movement of leaflets. The transient character of the MR favors a functional origin with an alteration in the geometry of the mitral apparatus. Some cases of so-called “eclipsed MR” are described in the literature, however, independently to electric shocks. Conclusion: In some patients, flash pulmonary edema seems to be due to transient severe functional MR, although the exact underlying physiopathologic mechanism remains unclear. An ischemic origin with papillary muscle dysfunction due to transient low perfusion could also be advocated. Aged Aged, 80 and over Atrial Fibrillation / therapy Diagnosis, Differential Echocardiography, Transesophageal Electric Countershock / adverse effects Female Humans Male Mitral Valve Insufficiency / diagnostic imaging Mitral Valve Insufficiency / etiology Severity of Illness Index Dewey 616 56 Département de médecine 221 false Echocardiography 30 2 19262b58-b0ba-47f8-ad5d-dc25430c795e Article (Published version) Restricted Published-echo-2013.pdf 183644 application/pdf 11ffdd894ce5ee4388cb41b1840d23ec6bf867362eef748ae7b65dc7f4fa8dc3 restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Transient Symptomatic Severe Mitral Regurgitation after Electric Cardioversion of Atrial Fibrillation	Echocardiography			2013	61	0

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Monnard, Simon