Extreme Clinico-Echocardiographic Discordance in End-Stage Degenerative Mitral Regurgitation: A Fatal Case of Silent Ventricular Burn-Out

O. Taoussi^1, , M. Zoubidi¹, M. Mokhtari¹, G. Benouna¹ and FZ. Merzouk¹

¹Department of Cardiology, Mohammed VI International University Hospital, Mohammed VI Foundation of Health and Sciences, Casablanca, Morocco

Cite this paper:
O. Taoussi, M. Zoubidi, M. Mokhtari, G. Benouna and FZ. Merzouk. Extreme Clinico-Echocardiographic Discordance in End-Stage Degenerative Mitral Regurgitation: A Fatal Case of Silent Ventricular Burn-Out. American Journal of Medical Case Reports. 2026; 14(1):1-4. doi: 10.12691/ajmcr-14-1-1

Abstract

Chronic degenerative mitral regurgitation (MR) can lead to profound, often asymptomatic, left ventricular (LV) remodeling. We report an exceptional and fatal case of end-stage MR, illustrating a dramatic mismatch between preserved clinical status and catastrophic structural damage on echocardiography. A patient with long-standing, untreated degenerative MR presented with minimal symptoms despite transthoracic echocardiography revealing extreme LV dilatation (end-diastolic diameter 105 mm), severe systolic dysfunction (ejection fraction 10-15%), torrential regurgitation (effective regurgitant orifice area 2.44 cm²), and massive left atrial enlargement. Strikingly, the clinical course was not dominated by heart failure symptoms but terminated abruptly in cardiac arrest due to ventricular fibrillation, likely precipitated by advanced LV dilatation, fibrosis, and electrical instability. This case underscores that end-stage degenerative MR can progress silently to an irreversible, lethal stage dominated by arrhythmic death, reinforcing the critical need for timely intervention before the onset of terminal remodeling.

Keywords:
End-Stage Mitral Regurgitation Left Ventricular Remodeling Echocardiography Ventricular Fibrillation Sudden Cardiac Death Clinical Discordance

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

References:

[1]	Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009 Apr 18; 373(9672): 1382-94.
[2]	Tribouilloy C, Rusinaru D, Grigioni F, Michelena HI, Vanoverschelde JL, Avierinos JF, Barbieri A, Pislaru SV, Russo A, Pasquet A, Théron A, Szymanski C, Lévy F, Enriquez-Sarano M; Mitral Regurgitation International Database (MIDA) Investigators. Long-term mortality associated with left ventricular dysfunction in mitral regurgitation due to flail leaflets: a multicenter analysis. Circ Cardiovasc Imaging. 2014 Mar; 7(2): 363-70.
[3]	Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, Ajmone Marsan N, Barili F, Bonaros N, Cosyns B, De Paulis R, Gamra H, Jahangiri M, Jeppsson A, Klautz RJM, Mores B, Pérez-David E, Pöss J, Prendergast BD, Rocca B, Rossello X, Suzuki M, Thiele H, Tribouilloy CM, Wojakowski W; ESC/EACTS Scientific Document Group. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2025 Nov 21; 46(44): 4635-4736.
[4]	Otto CM. Timing of surgery in mitral regurgitation. Heart. 2003 Jan; 89(1): 100-5.
[5]	Grigioni F, Enriquez-Sarano M, Ling LH, Bailey KR, Seward JB, Tajik AJ, Frye RL. Sudden death in mitral regurgitation due to flail leaflet. J Am Coll Cardiol. 1999 Dec; 34(7): 2078-85.
[6]	Kitkungvan D, Nabi F, Kim RJ, Bonow RO, Khan MA, Xu J, Little SH, Quinones MA, Lawrie GM, Zoghbi WA, Shah DJ. Myocardial Fibrosis in Patients With Primary Mitral Regurgitation With and Without Prolapse. J Am Coll Cardiol. 2018 Aug 21; 72(8): 823-834.
[7]	Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ; COAPT Investigators. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018 Dec 13; 379(24): 2307-2318.