Acute mitral valve regurgitation causing severe alveolar hemorrhage

Abstract

Background: Acute mitral regurgitation could occur without common symptoms like hemodynamic instability, but with dyspnea, hemoptysis, and right-sided infiltration on radiography. We report a case of severe alveolar hemorrhage caused by acute mitral regurgitation, which occurred in the absence of shock. Case Presentation: A 40-year-old man presented with dyspnea with bloody phlegm and hypoxia, despite being hemodynamically stable. Chest radiography revealed right-sided infiltration, and bronchoscopy showed fresh bloody phlegm in his tracheae. No specific findings were detected with any tests. After treatment with several medications and support with extracorporeal membrane oxygenation, his condition improved, although the etiology of the disease remained unknown. Transthoracic and transesophageal echocardiogram revealed severe mitral valve regurgitation with ruptured mitral chordae tendineae. These suggested that the sudden onset of mitral valve regurgitation had caused severe alveolar hemorrhage. Conclusion: Severe alveolar hemorrhage, especially with right-sided infiltration on chest radiography, should be considered a symptom of acute mitral regurgitation.

Hemoptysis and Unilateral Pulmonary Infiltrates due to Severe Acute Mitral Regurgitation from Papillary Muscle Rupture

“…Patients with AMR usually present with acute onset of shortness of breath and hypotension. Atypical presentations of AMR have been associated with unilateral lobar consolidation and alveolar hemorrhage [ 1 , 3 , 4 , 11 ]. Consistent with the previous literature, our case shows a symptom constellation of sudden dyspnea, hemoptysis, and right-sided infiltration.…”

“…AMR is an uncommon cause of hemoptysis, and nontraumatic cases are exceedingly rare [ 3 – 6 ]. AMR has also been seen to present with focal or unilateral pulmonary infiltrates, representing either cardiogenic pulmonary edema or, rarely, diffuse alveolar hemorrhage [ 3 , 7 – 10 ]. We present a case of AMR with an atypical presentation and without hemodynamic instability.…”

Surgically‐treated hemoptysis and alveolar hemorrhaging resulting from severe mitral regurgitation: A case report

“…In general, severe mitral regurgitation causes massive pulmonary hypertension and results in respiratory failure, which is sometimes severe enough to require mechanical cardiac support. 7 , 8 This is because an abrupt pressure elevation within the left atrium reflects back into the pulmonary circulation, leading to pulmonary hypertension and blood leakage from the capillaries. 9 In contrast, in the present case, pulmonary artery catheterization revealed a normal pulmonary artery pressure despite severe mitral regurgitation.…”

“…The last point is the relationship between mitral regurgitation and pulmonary hypertension. In general, severe mitral regurgitation causes massive pulmonary hypertension and results in respiratory failure, which is sometimes severe enough to require mechanical cardiac support 7,8 . This is because an abrupt pressure elevation within the left atrium reflects back into the pulmonary circulation, leading to pulmonary hypertension and blood leakage from the capillaries 9 .…”

Granulicatella adiacens Subacute Bacterial Endocarditis Presenting as Diffuse Alveolar Hemorrhage and Infection-Related Glomerulonephritis

“…Patients with this sign have an increased risk of mortality from delay of diagnosis. Patients usually have right-sided involvement greater than left due to the mitral valve's regurgitation jet flow, which is directed towards the upper right pulmonary vein causing back flow to the right side of the heart [ 13 ]. The left atrium does not have time to compensate for the acute pressure and will cause progressive dyspnea and hemoptysis.…”