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.

Monitored Anesthetic Care of Percutaneous Mitral Balloon Valvuloplasty for Severe Mitral Stenosis during Pregnancy: A case report / 대한마취과학회지

A woman presented severe mitral stenosis at 34 weeks' gestation. She did not respond to medical therapy, and underwent successful percutaneous mitral balloon valvuloplasty with monitored anesthetic care. The remainder of her pregnancy was uncomplicated, and she delivered a healthy infant at 38 weeks' gestation. We proved monitored anesthetic care is available method in percutaneous mitral balloon valvuloplasty for severe mitral stenosis during pregnancy.

Predictors of Thromboembolism in Severe Mitral Stenosis

OBJECTIVE: Systemic emboli related to atrial thrombi in severe mitral stenosis are a well known complication of percutaneous ballooon dilatation of the mitral valve(PMV). The purpose of this study was to identify factors that predicted left atrial thrombi and systemic embolism in patients with severe mitral stenosis. METHODS: Retrospective study of 79 patients with severe mitral stenosis by analysis of videotape having the record for transthoracic(TTE) and transesophageal echocardiography(TEE) was done over a 24 month period. RESULTS: The twenty eight patients(35%) had left atrial thrombus, and fifteen patients(19%) had experience of systemic embolization. Both appeared most commonly in the ages of 50 years. In thrombus group, the incidence of atrial fibrillation was more frequent(p=0.001), left atrial size larger(p=0.0014), and mitral valve area(p=0.0353) and ejection fraction of left atrial appendage(p=0.037) were lesser than non-thrombi group. In left atrial appendage(LAA) thrombus group, the left atrial dimension(p=0.0282) and the ejection fraction of LAA(p=0.008) were lesser than those in the left atrial thrombus group. In embolism group, the age was older(p=0.0212) and the incidence of atrial fibrillation tended to be more frequent(p=0.05470 than non-embolism group. CONCLUSION: In severe mitral stenosis, the formation of left atrial thrombus was related to presence of atrial fibrillation, size of left atrial dimension and area of mitral valve. And the thrombus of LAA was related to low ejection fraction of left atrium. The predictors of embolism in severe mitral stenosis were age and the presence of atrial fibrillation. The TEE was the useful diagnostic tool in detecting the thrombus of left atrium and LAA before PMV and the patients with predictors of thromboembolism should be treated more actively in severe mitral stenosis.