ArticleJACC. Case reports2026
Severe Mitral Regurgitation Triggered by Myocardial Ischemia in Hypertrophic Cardiomyopathy With Abnormalities of the Mitral Valve Complex.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMitral regurgitation (MR) is a common complication of hypertrophic cardiomyopathy. Clarifying the etiology is essential for its management. CASE SUMMARY: A 73-year-old man with hypertrophic obstructive cardiomyopathy with subsequent alcohol septal ablation presented with worsening dyspnea. Echocardiography revealed severe MR without systolic anterior motion. Imaging revealed that structural abnormalities of the mitral valve complex-including anterior displacement of the papillary muscle, abnormal chordal attachments, and leaflet degeneration-contributed to the MR severity. Coronary angiography revealed a silent occlusion of the right coronary artery. Ischemia-induced left ventricular hypokinesis with leaflet tethering is a critical functional contributor to MR. The patient underwent mitral valve replacement and coronary bypass grafting. Histopathological examination confirmed leaflet degeneration, shortened and thickened chordae tendineae, and ischemic injury to the papillary muscle, supporting multifactorial mechanisms of MR. DISCUSSION: MR in hypertrophic cardiomyopathy arises from combined structural and functional mechanisms, hence comprehensive multimodal evaluations are required for optimal treatment decisions.
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