Percutaneous Balloon Mitral Valvotomy and Percutaneous Coronary Intervention of Left Anterior Descending Artery in Combined Procedure

In countries like India rheumatic heart disease (RHD) is still a common problem, and with improvements in diagnosis and treatment, the lifespan of these patients is increased. With increase in the lifespan, these patients may develop coronary artery disease (CAD) and present as acute coronary syndrome (ACS). In some cases especially RHD with severe mitral stenosis (MS), thrombus that develop in left atrium may embolize in one of the coronary arteries, leading to acute coronary syndrome. We report a case of 51 year old female who was a known case of rheumatic heart disease and now presented with acute coronary syndrome. Patient was hemodynamically unstable and underwent percutaneous balloon mitral valvotomy (PBMV) and percutaneous coronary intervention (PCI) simultaneously. We here discuss the possible complications that need to be addressed in such scenario and how can we approach such cases. This is first of such intervention at our institute and also there are very few such records available online. Patient tolerated the procedure well with significant clinical improvement.

Role of Echocardiographic Imaging in Percutaneous Balloon Mitral Valvotomy.

Mitral stenosis (MS) is a still frequently encountered in India and Bangladesh. Untreated MS contributes to the morbidity and mortality. Balloon mitral Valvotomy is effective and commonly used for relief of obstruction in symptomatic patients. The case selection is guided by clinical characteristics and imaging. Echocardiography is the most important imaging modality to assess severity of obstruction its hemodynamic consequences as well as valve morphology. Transthoracic two dimensional echocardiography is usually sufficient to provide the desired information. Trans esophageal echocardiography is used when the valve cannot be adequately assessed by trans thoracic echocardiography and to exclude intracardiac thrombi prior to intervention. Three dimensional transthoracic and trans esophageal echocardiographic assessment provides more elaborate physiological and morphological information.

Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: Pathophysiology of hemodynamic collapse and peri-operative management issues.

Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri‑operative management issues in a case of mitral valve replacement for acute severe MR following BMV.

Percutaneous balloon mitral valvuloplasty for mitral stenosis with moderate mitral regurgitation / 中国介入心脏病学杂志

Objective To evaluate the effects of percutaneous balloon mitral valvotomy (PBMV) for mitral stenosis (MS) with moderate mitral regurgitation (MR), particularly with bad mitral condition. Methods PBMV was performed in 62 patients with both MS and MR, of whom 7 had bad mitral condition, and the changes of mitral valve area, mean left atrial pressure , mitral valve gradient, cardiac function and left ventricular maximal diameter were observed. Results Mitral valve area increased from (0.83?0.18) cm 2 to (1.86?0.24) cm 2 (P