PMC9411994_01
PMC9411994_02
(A) TTE parasternal long axis demonstrating bileaflet MV prolapse and MAD (red arrow). (B) Induction of polymorphic ventricular tachycardia during electrophysiology study.
fcvm-09-976066-g0001.jpg
PMC9411994_02_fcvm-09-976066-g0001.jpg
F1
Ischemic work-up was negative for CAD by coronary CT angiography and TTE showed normal LVEF with bileaflet MVP, moderate MR and MAD (Figure 1A), with mild hypokinesis of the inferolateral wall and LGE seen in the inferior and inferolateral walls on CMR. Given concern for an arrhythmogenic cause of syncope, an electrophysiology study was performed with induction of polymorphic ventricular tachycardia (Figure 1B) and subsequently an ICD was implanted.
PMC9411994_03
(A) Intraprocedural TEE showing a myxomatous MV with bileaflet prolapse and MAD. (B) Intraprocedural TEE showing severe MR. (C) Status post placement of two MitraClips with improved MR. (D) CMR demonstrating mid-inferior wall LGE.
fcvm-09-976066-g0002.jpg
PMC9411994_03_fcvm-09-976066-g0002.jpg
F2
A TEE and stress echocardiogram were performed which confirmed severe MR and showed a lack of contractile reserve with peak exercise (Figures 2A,B). CMR showed a mildly reduced LVEF with presence of diffuse myocardial fibrosis and LGE in the mid-inferior wall (Figure 2D). Patient underwent percutaneous MV repair with two MitraClips, with significant improvement in MR (Figure 2C).
PMC9411994_04
PMC9411994_05