ABSTRACT
This article presents the case of a 53-year-old female attorney who underwent successful mitral valve repair for mitral valve prolapse. The patient's postoperative course was marked by refractory pain, fatigue, shortness of breath, refusal to ambulate, frequent episodes of tearfulness, and a postsurgical decline in ejection fraction through postoperative week 4. Her slow recovery prompted a psychiatric consult, during which she reported panic and a fear of "losing it." After respective presentations of the case from the cardiology and psychiatry perspectives, the article concludes with a moderated discussion of the case to explore insights it provides into heart-brain interactions.
Subject(s)
Depression/complications , Fatigue/psychology , Mitral Valve Insufficiency/surgery , Mitral Valve Prolapse/surgery , Adaptation, Psychological , Affect , Antidepressive Agents/therapeutic use , Depression/drug therapy , Fatigue/etiology , Female , Humans , Middle Aged , Mitral Valve Insufficiency/psychology , Mitral Valve Insufficiency/rehabilitation , Mitral Valve Prolapse/psychology , Mitral Valve Prolapse/rehabilitation , Postoperative Period , Psychophysiology , Risk Factors , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
Between January 1993 and June 1996, 108 patients with non-rheumatic mitral regurgitation (MR) underwent surgical treatment. Mitral valvuloplasty (MVP) was performed in 94 patients (87%) and mitral valve replacement (MVR) was performed in 14 patients. The patients were reviewed based on the location of the prolapse, active endocarditis, and re-valvuloplasty. The proportion of MVP patients to the total number of cases was 92%, 96% and 94% for prolapse of the anterior mitral leaflet (MVP: n = 22), the posterior mitral leaflet (n = 47) and of both leaflets (n = 15), respectively; it was 60% and 33% in the patients with active infective endocarditis (n = 3) and in reoperation cases (n = 3). Reoperation was required in 2 patients. Other than reoperation cases, 3/4 grade MR was detected by color Doppler echocardiography in 6 patients although they were asymptomatic. Thromboembolism occurred in 3 patients. The event-free rate at 42 months was 80.4%. Concomitant maze procedure was performed in 36 of 39 patients with atrial fibrillation and normal sinus rhythm was obtained in 25 of the 36 patients. Only 6 patients received warfarin anticoagulation after MVP. In current cases with non-rheumatic MR, the MVP could be performed in 87% of all patients and in 94% of the patients with simple prolapse, regardless of the prolapse area. Concomitant maze procedure might provide a better quality of life after MVP.
