Post on 25-Feb-2020
Dr Sanjay Rajdev, DM, FACCSevenHills Hospital, Mumbai
Single Operator Percutaneous Balloon Mitral Valvotomy with Device Closure of Atrial Septal Defect in a Case of Lutembacher
Syndrome under Trans-esophageal Guidance
Case History
1. 18 year old mother of one presented with shortness of breath on exertion along with palpitation of 2 years duration
2. Her first pregnancy and delivery at age 16 was uneventful, she noticed mild worsening of breathlessness for which she received diuretics
3. She wanted to conceive again and complete her family
Labs
1. Clinical Exam was remarkable for ESM grade III/VI at LLSB
2. S1 mildly accentuated, diastolic murmur could be auscultated in TA
3. S2 was perceived splitting widely
4. ECG: Inferior axis
5. Echo: RHD, Significant MS (MVA 1.1 cm2), Large ASD 22 mm with L R shunt
DIAGNOSIS: LUTEMBACHER SYNDROME
First Stage in Percutaneous Rx: BMV
Second Stage: ASD Device Closure
Device in Released Position
Post procedure TTE Images
Post procedure TEE Images
• Short Axis
Modified short axis
Post procedure TEE Images
SVC –IVC View
Conclusion
1. Lutembacher Syndrome is an uncommon clinical condition.
2. For selected individuals with favourableanatomy, a percutaneous treatment with balloon mitral valvotomy followed by ASD device closure is a treatment option.
3. The procedure is feasible using single operator with strategically placing equipment in the catheterization laboratory.