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.