PMC9825327_01
(A) Transoesophageal echocardiography showing a severe eccentric mitral regurgitation jet; (B) transoesophageal echocardiography showing a prolapse of the posterior leaflet (P2) with an incomplete systolic coaptation.
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These data were subsequently confirmed with transoesophageal echocardiography (TEE) (Figure 1A, B; Supplementary material online, files S1 and S2).
Mullins sheath (8F) is seen gently 'tenting' on the fossa in the right atrium, while a sinus bradycardia (43 beats per minute) is noted.
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(A) Electrocardiogram shows a high degree atrioventricular block and ST-segment elevation in inferior leads. Coronary angiography reveals multiple coronary spasms; (B) coronary angiogram was rechecked with extracorporeal membrane oxygenation support and no stenosis was found in the right coronary artery and left circumflex artery. Electrocardiogram showed an improvement of ST-segment elevation.
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Continuous cardiopulmonary resuscitation, defibrillation, and intravenous epinephrine were routinely undertaken, and immediately, coronary angiogram from the left femoral artery showed a severe vasospasm in the proximal right coronary artery (RCA) with 99% stenosis and with the LCX 100% occluded, although the LAD artery was still patent (Figure 3A). Coronary angiogram was re-checked with ECMO support after minutes, and no stenosis was found in the RCA and LCX (Figure 3B).