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Ebstein Anomaly — EECC MCQ

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HardCongenital Heart Disease (Adult)Ebstein AnomalyEECC

A patient with severe primary mitral regurgitation reports no limitation, but exercise echocardiography reproduces breathlessness, raises pulmonary artery systolic pressure to 66 mmHg and shows no contractile reserve. Resting LVEF is 64% and LV dimensions are below conventional surgical thresholds. How should this result be used?

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Correct answer: E — Valve-team referral for exercise-unmasked adverse physiology

The best answer is “Valve-team referral for exercise-unmasked adverse physiology”. Exercise-induced symptoms, marked pulmonary-pressure rise and absent contractile reserve reveal that apparently asymptomatic severe regurgitation is physiologically consequential and should influence intervention timing. “discount the exercise result because resting LVEF is preserved” is less appropriate because normal resting LVEF can mask early dysfunction in chronic mitral regurgitation “Start pulmonary vasodilator monotherapy for primary pulmonary hypertension” is less appropriate because the pulmonary pressure rise is secondary to valve disease rather than proven pulmonary arterial hypertension “Wait until resting LVEF is below 40%” is less appropriate because waiting for LVEF below 40% represents advanced irreversible dysfunction “Use balloon mitral commissurotomy for the regurgitation” is less appropriate because commissurotomy treats stenotic commissural fusion rather than primary regurgitation

Reference: 2025 ESC/EACTS Guidelines for valvular heart disease. https://academic.oup.com/eurheartj/article/46/44/4635/8234488