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Congenital mitral stenosis: challenge of percutaneous transvenous mitral commissurotomy
G Y Chen1, C D Tseng, F T Chiang
1Department of Internal Medicine, Provincial Tao-Yuan General Hospital, Taiwan, Republic of China.
Insights
Percutaneous mitral commissurotomy is not recommended for adults with congenital mitral stenosis and asymmetric, hypoplastic valves. This procedure can lead to chordae tendineae rupture and necessitate mitral valve replacement.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Congenital mitral stenosis presents unique challenges in adult patients.
- Embolic stroke is a potential complication of mitral valve disease.
- Treatment decisions for congenital mitral stenosis require careful consideration of valve morphology.
Observation:
- A 26-year-old woman with congenital mitral stenosis and prior embolic stroke underwent evaluation.
- Echocardiography revealed a hypoplastic posterior mitral leaflet with abnormal chordal attachments.
- Mitral valve area was significantly reduced (0.9 cm2).
Findings:
- Percutaneous transvenous mitral commissurotomy was attempted due to patient/family refusal of surgery.
- Chordae tendineae rupture occurred during the percutaneous procedure.
- Mitral valve replacement became necessary following the complication.
Implications:
- Percutaneous transvenous mitral commissurotomy may be contraindicated in adult congenital mitral stenosis with specific valve anomalies.
- Asymmetric and hypoplastic mitral valve morphology increases procedural risk.
- Careful patient selection is crucial for interventional procedures in complex congenital heart disease.
Abstract:
A 26-year-old woman with congenital mitral stenosis and embolic stroke was referred to our hospital. The echocardiogram showed a hypoplastic posterior mitral valve leaflet with short, unbalanced chordal attachments to the posteromedial papillary muscle. The mitral valve area was 0.9 cm2 by the pressure half-time method. There was no left atrial thrombus and spontaneous echo contrast. Percutaneous transvenous mitral commissurotomy was performed since the suggestion of surgical management was refused by her family members. A rupture at the chordae tendinae of the hypoplastic posterior papillary muscle developed during the procedure and needed mitral replacement. We advise that percutaneous transvenous mitral commissurotomy be avoided in adult patients with congenital mitral stenosis having an asymmetric and hypoplastic mitral valve.