CLINICAL PRESENTATION
38-year-old women presented with recurrent symptoms of congestive heart failure, including dyspnea, lower-extremity edema, and ascites due to idiopathic dilated cardiomyopathy diagnosed two years ago, complicated with functional mitral and tricuspid regurgitation. Both coronary angiography and cardiac magnetic resonance were performed at the time with no significant abnormality.
Her past medical history revealed permanent atrial fibrillation.
In view of her worsening heart failure symptoms with recurrent hospitalizations despite optimal heart failure treatment, the decision of surgical management of her biventricular dilated cardiomyopathy was taken and the patient was admitted in our department for a mitral and tricuspid valve repair surgery.
On admission, initial physical exam reveals temperature 37 °C, heart rate 87 bpm, blood pressure 101/70 mmHg, Cardiac physical examination revealed irregularity of heart sounds S1 and S2, holosystolic murmur (grade 4/6) radiating to the axilla and holosystolic murmur (grade 3/6) at the left lower sternal border. Other physical checks were within normal limits.
Electrocardiography (ECG) examination revealed atrial fibrillation, and chest X-rays showed cardiomegaly.
Transthoracic echocardiography revealed global severe left ventricular dysfunction, ejection fraction (EF) of 25%, severe left ventricular dilatation with left ventricular end diastolic diameter (LVEDD) 68 mm, severe functional mitral valve regurgitation (MR) with central jet (effective regurgitation orifice 0.30 cm2, regurgitation volume 63 ml), and concomitant systolic dysfunction of dilated right ventricle (low TAPSE of 15 mm) with severe tricuspid valve regurgitation grade (TR). Bi-atrial enlargement was also noted (figure 1).
Results of complete blood count, inflammatory markers (C-reactive protein), electrolytes, serum creatinine, liver enzymes, and thyroid hormones were in normal ranges. Heart failure therapy was optimal.
She underwent a mitral valve restrictive annuloplasty with a Carpentier ring N°28 (figure 3)in addition to annuloplasty ring N° 30 mm.
The patient was discharged from the hospital on day 14 after an uneventful post operative course.
At the 6-month postoperative follow-up, the patient showed continuous improvement of her symptoms, besides, repeat transthoracic echocardiography also showed an improved of left ventricle dimensions and function with left ventricle EF increased to 40% (figure 2).