Acute mitral insufficiency as a consequence of long-distance run

The acute mitral insufficiency is a life-threatening condition that may be caused by heavy physical strain, especially during the simultaneous occurrence of the myxomatous degeneration of the mitral valve. The mortality of the untreated illness is 75% during the first 24 h after the occurrence; the perioperative mortality is also high.The case study describes the story of a 57-year-old male, an active sportsman (long-distance runner), whose health condition was duly examined in an institute of sport medicine in Germany, and the results were reportedly always normal. Immediately after finishing a marathon run here, in Prague, he began to complain of severe dyspnea, NYHA III–IV. The physical examination revealed clearly audible strong systolic murmur with the amplitude on the heart apex with propagation into the left axilla, and the signs of pulmonary congestion were present. The transthoracic echocardiography confirmed the suspected acute mitral regurgitation, with a minor dilatation of the left atrium, and the hyperkinetic left ventricle with the preserved systolic function (EF 70%).After the confirming examination using transoesophageal echocardiography, the surgical revision of the mitral valve was indicated. This revealed myxoid degeneration of both leaflets of the mitral valve, tendinous cord rupture, and the dilatation of its annulus. A successful preservation operation was performed, together with the mitral plastic surgery, annuloplasty, and tendinous cord replacement. Having recovered from the difficulties of the post-surgery period, the patient was released to the domestic care on the 14th day after the operation.