In athletes with chronic mitral regurgitation, perioperative cardiogenic shock risk is high if acute MR is presumed; preoperative hemodynamic optimization is critical.
Presuming acute MR in athletes with chronic remodeling carries a high risk of perioperative decompensation and cardiogenic shock, necessitating careful preoperative hemodynamic optimization.
Absolute Event Rate: 0% vs 0%
Abstract Mitral regurgitation (MR) poses challenges in distinguishing acute from chronic aetiologies in compensated patients. A 48-year-old male rugby player presented with 2 weeks of worsening dyspnoea on a background of chronic bilateral lower limb cellulitis. Found in atrial fibrillation, transoesophageal echocardiography revealed flail P2 with severe MR, ejection fraction 35%, and severe left ventricular dilation—indicating chronicity despite acute symptoms. He underwent urgent mitral valve repair. Post-induction instability necessitated emergency cardiopulmonary bypass. Repair consisted of P2 triangular resection, neochordae, and Cosgrove annuloplasty band. Weaning failed; central veno-arterial extracorporeal membrane oxygenation was instituted with open chest. Decannulated day 4, complications included anuric acute kidney injury requiring dialysis, pneumonia, and critical illness myopathy. Ejection fraction improved to 30% on medical therapy. This case underscores risks of presuming acute MR in athletes with chronic remodelling, where perioperative decompensation can precipitate shock. Preoperative haemodynamic optimization is critical to mitigate such events.
Walsh et al. (Sat,) reported a other. In athletes with chronic mitral regurgitation, perioperative cardiogenic shock risk is high if acute MR is presumed; preoperative hemodynamic optimization is critical.