Supramitral Membrane with Left Atrial Appendage Thrombus: A Rare Entity

A 4?year?old child with supramitralmembrane (SMM) causing severemitral stenosis (MS) was taken for excision of themembrane. Intraoperative transesophageal echocardiography showed a large thrombus in the left atrial appendage (LAA) in addition to SMM.The case underscores the importance of this extremely rare association and prompt therapy to prevent catastrophic consequences.

Study of Congenital Mitral Stenosis Cases Requiring Surgical Correction in the First 2-Years of Life

PURPOSE: Congenital mitral stenosis(CMS) is a rare anomaly accounting for 0.4-0.5% of total heart disease. CMS which cases needed surgical correction in infancy are even rare. In this study, we analyzed 11CMS patients of less than 2 year of age who needed surgical corrections, in order to find out their diagnoses, the characteristics, the results of operation and prognoses, and the progress of disease without surgical correction. METHODS: Retrospective studies were performed on eleven CMS patients of less than 2 years of age admitted to Sejong General Hospital between Jan. 1989 and Aug. 1999. RESULTS: The surgeries were performed on 9 out of 11 enrolled patients. The median age was 8(3-20) months and the median weight was 5(4-9)kg. The mitral valves of the patients were classified anatomically as supramitral ring(4), parachute mitral valve(3), "typical" symmetric hypoplastic mitral valve(2) and asymmetric hypoplastic mitral valve(2). Three patients died after the surgical correction. Among them, fibroelastosis of left ventricle was found during the surgery in two cases, and the other case was considered to be in Eisenmenger state. 5. Reoperations were performed on 3 out of 6 surviving patients. While one case was an early reoperation, two case were late ones. CONCLUSION: The patients with severe CMS under the age of two can be surgically corrected with an acceptable success rate. Poor results were observed, however, if the decisions for surgical intervention were delayed.

A Case Report: Implantation of Balloon-Expandable Stent for Coarctation of the Aorta, Associated with Congenital Mitral Stenosis

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.

A Case Report: Implantation of Balloon-Expandable Stent for Coarctation of the Aorta, Associated with Congenital Mitral Stenosis

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.