Severe acute mitral valve regurgitation in a COVID-19-infected patient

BMJ Case Rep. 2021 Jan 18;14(1):e239782. doi: 10.1136/bcr-2020-239782.


The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.

Keywords: Cardiovascular medicine; General practice / family medicine; Infectious diseases; Medical education; Valvar diseases; cardiovascular medicine; general practice / family medicine; infectious diseases; medical education; valvar diseases.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Acute Disease
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / physiopathology
  • COVID-19 / complications*
  • COVID-19 / therapy
  • Chordae Tendineae / diagnostic imaging
  • Echocardiography
  • Electrocardiography
  • Heart Valve Prosthesis Implantation
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / etiology*
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery
  • Pulmonary Edema / etiology
  • Pulmonary Edema / physiopathology
  • Pulmonary Edema / therapy
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy
  • SARS-CoV-2
  • Severity of Illness Index
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / physiopathology