Shiwaku Yudai, Aonuma Tatsuya, Kitani Yuya, Takeuchi Toshiharu, Naoki Nakagawa
Division of Cardiology and Nephrology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka-higashi, Asahikawa 0788510, Japan.
Eur Heart J Case Rep. 2025 Jul 25;9(8):ytaf353. doi: 10.1093/ehjcr/ytaf353. eCollection 2025 Aug.
Fulminant eosinophilic myocarditis (EM) has a poor prognosis. Acute severe mitral regurgitation (MR) is a life-threatening complication of EM: however, no established treatment thereof exists.
Herein, we report a case of a 70-year-old woman diagnosed with fulminant EM. She was in cardiogenic shock and treatment was initiated with an implanted intra-aortic balloon pump in addition to steroids and inotropes. Functional MR gradually worsened, and cardiogenic shock did not improve. Our cardiology team discussed the treatment plan and performed transcatheter mitral valve repair (TMVr). Immediately after the procedure, MR was well-controlled, and the patient's hemodynamics improved dramatically. After discharge, there was no recurrence of heart failure.
We identified two important clinical issues: first, acute functional MR requiring invasive treatment can be associated with fulminant EM; and second, TMVr is useful as an invasive treatment strategy for such MR. Although MR caused by EM improves with pharmacological therapies in many cases, invasive treatment strategies may be required in some case, as seen in this case. Compared with surgeries, TMVr is less invasive and carries a lower risk of postoperative low cardiac output syndrome compared with surgical procedures when MR is well-controlled. If the response to pharmacological therapies is poor, early TMVr should be considered.
暴发性嗜酸性粒细胞性心肌炎（EM）预后较差。急性重度二尖瓣反流（MR）是EM的一种危及生命的并发症：然而，目前尚无既定的治疗方法。
在此，我们报告一例70岁女性被诊断为暴发性EM的病例。她处于心源性休克状态，除了使用类固醇和强心剂外，还启动了主动脉内球囊反搏治疗。功能性MR逐渐恶化，心源性休克未改善。我们的心脏病学团队讨论了治疗方案并进行了经导管二尖瓣修复术（TMVr）。术后即刻，MR得到良好控制，患者的血流动力学显著改善。出院后，心力衰竭未复发。
我们确定了两个重要的临床问题：第一，需要侵入性治疗的急性功能性MR可能与暴发性EM相关；第二，TMVr作为此类MR的侵入性治疗策略是有用的。尽管在许多情况下，由EM引起的MR可通过药物治疗得到改善，但在某些情况下，如本病例所示，可能需要侵入性治疗策略。与手术相比，TMVr的侵入性较小，当MR得到良好控制时，与手术相比，术后低心输出量综合征的风险较低。如果对药物治疗反应不佳，应考虑早期TMVr。
