Preoperative management of deteriorating mitral regurgitation and heart failure with continuous positive airway pressure.

A 75-year-old Japanese woman with acute mitral valve prolapse and regurgitation, that developed one month previously, suffered from intractably progressive congestive heart failure (CHF). However, the emergent surgery was declined, and pharmacological treatment was discontinued due to hypotension and malignant arrhythmia. She was treated with 5-8 cmH2O of continuous positive airway pressure (CPAP) to manage CHF and Cheyne-Stokes respiration during the preoperative period of five weeks, after which plastic surgery of the mitral valve was successfully performed. CPAP can be an effective non-pharmacological treatment for CHF, unloading the left ventricle hydrostatically in order to reduce mitral regurgitation and improve oxygenation.