Key result
Exercise stress echo identifies absent biventricular contractile reserve, predicting high surgical risk in severe MR.
Case Report (n=1)
No
This case highlights the utility of pre-operative stress echocardiography for risk stratification and periprocedural planning in patients with severe mitral regurgitation undergoing cardiac surgery.
Warrants MCS preparedness for similar high-risk MR cases; leaves open prospective validation of stress echo reserve testing.
We present the case of a 52‐year‐old male with severe primary mitral regurgitation, with biventricular dilatation and systolic impairment. Pre‐operative exercise stress echocardiography revealed absence of left and right ventricular contractile reserve suggestive of increased surgical risk possibly requiring postoperative mechanical circulatory support. In the immediate postoperative period, the transesophageal echocardiogram revealed severe left ventricular systolic impairment with very low cardiac output, resulting in significant challenges in weaning the patient off cardiopulmonary bypass. Left ventricular function gradually improved with judicious use of intravenous fluids and inotropic support. Our case highlights the importance of stress echocardiography in the risk stratification and periprocedural planning of patients undergoing cardiac surgery for severe mitral regurgitation.
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Vlachou et al. (2026) conducted a case report in Severe primary mitral regurgitation with biventricular dilatation and systolic impairment (n=1). Pre-operative exercise stress echocardiography was evaluated. Pre-operative exercise stress echocardiography in a 52-year-old male with severe mitral regurgitation identified absent biventricular contractile reserve, accurately predicting high surgical risk.
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