Assessment of Valvular Oxidative Stress in a Young Patient with Primary Severe Mitral Regurgitation
1 Department of Functional Sciences – Pathophysiology, “Victor Babeș” University of Medicine and Pharmacy, 2 EftimieMurgu Sq., 300041 Timișoara, Romania; (L.N.I.); (D.M.M.); (A.S.)
2 Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, 2 EftimieMurgu Sq., 300041 Timișoara, Romania
3 Department of Cardiology – Cardiology II, “Victor Babeș” University of Medicine and Pharmacy, 2 EftimieMurgu Sq., 300041 Timișoara, Romania; (A.S.P.); (C.M.); (A.I.)
4 Center for Cardiovascular Diseases Research, Institute of Cardiovascular Diseases, 13A Gheorghe Adam Str., 300310 Timișoara, Romania
5 Department of Cardiology – Cardiovascular Surgery, “Victor Babeș” University of Medicine and Pharmacy, Institute of Cardiovascular Diseases, 13A Gheorghe Adam Str., 300310 Timișoara, Romania;
* Correspondence: (R.Ș.); (C.T.L.)
* Author to whom correspondence should be addressed.
Received: 15 May 2021 / Revised: 29 Jun 2021 / Accepted: 20 Aug 2021 / Published: 29 Dec 2021
Abstract
Mitral valve regurgitation (MR) is the most common valvular heart disease. Diagnosing and managing mitral regurgitation is often challenging and requires a structured approach, integrating findings on history, physical examination and imaging. A common cardiac anomaly is myxomatous mitral valve prolapse. Excess myxomatous leaflet tissue, bileaflet prolapse or billowing, chordae elongation and annular dilatation are all features of Barlow’s disease. Currently, there is no successful pharmacological treatment available to prevent or slow its progression. Here, we report the case of a 30-year-old male patient, with no previous significant medical background and no medication at home, who was diagnosed with severe mitral regurgitation at a regular check-up and was admitted to our clinic with mild exertion dyspnea and fatigue. Transthoracic echocardiography showed intensely thickened mitral leaflets with a myxomatous appearance, prolapse of the middle scallop of the posterior leaflet (P2), apparently with ruptured chordae, and severe mitral regurgitation with a holosystolic eccentric jet. While oxidative stress is a central pathomechanism of cardiovascular disease, information regarding valvular oxidative stress in the literature is rather scarce. In this respect, we assessed oxidative stress through confocal microscopy in a sample of a mitral valve harvested during valvular surgery. We found an increased production of reactive oxygen species in the mitral valve sample that was alleviated after incubation with the angiotensin 2 receptor type I (AT1) antagonist irbesartan. This case is worth mentioning as a starting point for a prospective study aimed at assessing the role of valvular oxidative stress and mitochondrial dysfunction in patients with various degrees of primary and secondary mitral regurgitation.
Keywords: primary severe mitral regurgitation; Barlow’s disease; transesophageal echocardiography; oxidative stress; angiotensin 2 receptor antagonist
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CITE
Ionică, L.N.; Șoșdean, R.; Pescariu, A.S.; Mornoș, C.; Muntean, D.M.; Ionac, A.; Sturza, A.; Luca, C.T.; Feier, H. Assessment of Valvular Oxidative Stress in a Young Patient with Primary Severe Mitral Regurgitation. Timisoara_Med 2021, 2021, 1.
Ionică LN, Șoșdean R, Pescariu AS, Mornoș C, Muntean DM, Ionac A, Sturza A, Luca CT, Feier H. Assessment of Valvular Oxidative Stress in a Young Patient with Primary Severe Mitral Regurgitation. Timisoara Medical Journal. 2021; 2021(2):1.
Ionică, Loredana Nicoleta; Șoșdean, Raluca; Pescariu, Alexandru Silvius; Mornoș, Cristian; Muntean, Danina Mirela; Ionac, Adina; Sturza, Adrian; Luca, Constantin Tudor; Feier, Horea. 2021. "Assessment of Valvular Oxidative Stress in a Young Patient with Primary Severe Mitral Regurgitation." Timisoara_Med 2021, no. 2: 1.
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