Major regression of severe mitral regurgitation in an adult with congenital heart disease and cardiac resynchronization therapy

A 48-year-old woman with congenital heart disease was referred to our centre for refractory right and left heart failure. She was born with a pulmonary stenosis associated with an atrial and ventricular septal defect and underwent a surgical repair at the age of 16. From the age of 44, she gave a history of decline with repetitive episodes of decompensated heart failure. Resting ECG showed a sinus rhythm and a right bundle branch block. Echocardiography demonstrated biventricular dysfunction, severe mitral regurgitation, and major ventricular dyssynchrony measured with tissue Doppler imaging. Transvenous biventricular pacing (BVP) device was instituted with lateral left ventricular lead placement and resulted in an immediate decrease in QRS width (from 160 to 128 ms) and in left ventricular dyssynchrony (from 66 to 18 ms) and an increase in left ventricular d P /d tmax (from 498 to 652 mmHg/s). The image shows the spectacular decrease in mitral regurgitation with biventricular pacing ( Figure 1 ). The effective regurgitant orifice area decreased from 24 to 5 mm 2 . After 6 months of BVP, symptoms and exercise tolerance improved markedly from New York Health Association class III to class I with a maximal oxygen uptake on exercise testing increased by 21%. Echocardiography demonstrated a significant right and left ventricular reverse remodelling and a complete regression of mitral regurgitation. What the figure shows is the spectacular decrease in mitral regurgitation with biventricular pacing. BVP improved functional mitral regurgitation by correcting all the underlying mechanisms (reduced contractility, ventricular asynchrony, and ventricular remodelling) and may be an interesting therapeutic option in patients with congenital heart disease, ventricular dyssynchrony, and severe functional mitral regurgitation. 1 , 2 Conflict of interest : none declared.