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Transseptal mitral balloon valvotomy in patients with atrial septal aneurysms
D Rittoo1, G R Sutherland, T R Shaw
1Department of Cardiology, Western General Hospital, Edinburgh, UK.
Insights
Transseptal mitral balloon valvotomy is safe for patients with atrial septal aneurysms. Procedures were successful, even when performed through the aneurysm wall or a patent foramen ovale, with no major complications.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Mitral balloon valvotomy is a common procedure for mitral stenosis.
- Atrial septal aneurysms are rare cardiac anomalies that can complicate transseptal procedures.
Observation:
- Transthoracic and transoesophageal echocardiography identified atrial septal aneurysms in 3 patients undergoing mitral balloon valvotomy.
- Two patients had a patent foramen ovale, obviating the need for septal puncture.
- In one patient, transseptal catheterization was successfully performed through the aneurysm wall.
Findings:
- All 3 patients with atrial septal aneurysms underwent successful transseptal mitral balloon valvotomy.
- No significant complications were observed during or after the procedures.
- Oximetry and transoesophageal colour flow imaging showed minimal or no left-to-right interatrial shunting.
Implications:
- Transseptal mitral balloon valvotomy is a feasible and safe approach in patients with atrial septal aneurysms.
- The presence of a patent foramen ovale can facilitate the procedure in these patients.
- Echocardiography plays a crucial role in diagnosing atrial septal aneurysms and planning the intervention.
Abstract:
Transthoracic and transoesophageal echocardiography (TTE, TEE) were performed in 130 consecutive patients referred for mitral balloon valvotomy. Atrial septal aneurysms were diagnosed by TTE and TEE in 2 and 3 patients, respectively. All 3 patients underwent mitral balloon valvotomy via the transseptal route. The foramen ovale was found to be patent in 2 of these patients, thus rendering puncture of the interatrial septum unnecessary. In the 3rd patient transseptal catheterisation was performed through the wall of the aneurysm itself. There were no significant complications in any of these patients. No left-to-right interatrial shunting could be demonstrated by oximetry in any of the 3 patients. Transoesophageal colour flow imaging showed trivial shunting in 2 patients and none in the 3rd. Transseptal mitral balloon valvotomy can be performed safely in patients with atrial septal aneurysms, especially in those with co-existent patent foramen ovale.