Left Atrial Remodelling and Recurrence of Congestive Heart Failure in Patients Initially Diagnosed with Heart Failure

A 52-year-old man had a history of heart failure (HF) with severe mitral regurgitation (MR) due to P3 prolapse 4 years ago. He underwent mitral valve plasty with triangular resection, edge-to-edge anastomosis, and annuloplasty with a 30 mm Physioring. After the surgery, HF improved and postoperative echocardiography confirmed a normal sized left ventricle (LV) and normal ejection fraction (EF). There were preserved mitral valve opening with mitral valve area (MVA) of 1.8 cm, a mean pressure gradient of 4.4 mmHg, and no residual MR. However, he developed HF again 4 years later. Two-dimensional echocardiography demonstrated moderately dilated LV, reduced LV EF of 40%, and mild MR. There was also limited mitral valve opening caused by dilated LV, resulting in MS with an MVA of 1.2 cm, and a mean pressure gradient of 8.4 mmHg. Both the etiologies of the MS and MR were considered as functional. His HF symptom disappeared after initiation of vasodilators and diuretics. Repeated echocardiography after HF treatment demonstrated a reduction of LV size without MR, improvement of mitral valve opening to an MVA of 1.7 cm, and a mean pressure gradient of 4.6 mmHg. We report a case of HF and functional MS after MV plasty, which were reversed by aggressive medical treatment for HF.