Paroxysmal hypotension and hypoxaemia caused by severe dynamic secondary mitral and tricuspid regurgitation after acute myocardial infarction

A 57-year-old male patient developed paroxysmal hypotension and hypoxaemia during endotracheal extubation post-acute myocardial infarction revascularization. The underlying cause was severe dynamic mitral regurgitation (MR) and secondary tricuspid regurgitation. After successful extubation and weaning, the patient's MR nearly resolved. Discharged in improved condition with guideline-directed medical therapy, the patient was soon readmitted for heart failure with pulmonary oedema. The transthoracic echocardiogram confirmed recurrent, worsening MR. Transcatheter edge-to-edge repair was successfully performed, reducing the patient's severe MR to trivial and resolving tricuspid regurgitation completely. At 1-year follow-up, the patient remained stable with improved cardiac function and no readmissions for cardiac causes.