Right heart/pulmonary circulation unit assessment during exercise, a need for a global view of the loop

Abstract : We read with interest the case report recently published by Maréchaux et al. [1]. The authors reported a case of dynamic mitral regurgitation (MR) in a 67-year-old woman who has been treated for a long-time by gynergen for migraine prophylaxis. This patient had a severe dyspnea with normal left ventricular (LV) function, mild MR and no pulmonary hypertension (PH) at rest. The exercise echocardiography revealed a dramatic increase of both MR and systolic pulmonary arterial pressure (sPAP) at a very low exercise load (45 W).