Severe mitral stenosis in the long-term evolution of myotomy-myectomy-septal resection.

258 ment and are indicated for more aggressive therapies, such as myotomy-myectomy-septal resection, dual-chamber pacemaker implantation, alcohol injection in the septal artery, defibrillator implantation (used in cases at high risk for sudden death), and even heart transplantation 3,4. Mitral stenosis is usually of rheumatic origin, occurring mainly among women (approximately 66% of the cases), but in rare cases, it may be congenital 7. Pure or predominant mitral stenosis occurs in approximately 40% of all patients with rheumatic heart disease 7. The clinical findings are extremely varied and have a significant relation with the degree of valvular impairment. These findings may vary from the mere presence of some clinical signs without symptoms until the presence of pulmonary edema, atrial arrhythmias, hemoptysis, and right ventricular failure 7. Until the present time, however, from the pathophysiological point of view, no cases of an association of myotomy-myectomyseptal resection and the appearance of long-term mitral stenosis have been reported in the scientific literature. We report the case of a 67-year-old female, who, 18 years after undergoing myotomy-myectomy-septal resection for correction of asymmetric septal hypertrophic cardiomyopathy, had symptoms of severe mitral stenosis. The patient presented to the Instituto do Coração (InCor) of the Hospital das Clínicas of the FMUSP for appropriate clinical assessment, being then referred for surgery.