Percutaneous Mitral Valvotomy in a Patient with Lutembacher Syndrome as a Bridge to Definitive Surgical Intervention

A 45-year-old female Jehovah’s Witness patient was diagnosed with Lutembacher syndrome, New York Heart Association (NYHA) class IV congestive heart failure (CHF), and severe malnutrition. An echocardiogram showed a 38 mm diameter ostium secundum atrial septal defect with a mitral valve area of 0.5 cm2 and a Wilkins score of 10. The patient had severe pulmonary hypertension at an estimated systolic pressure of 96 mmHg. In addition, the right ventricle presented with significant dilation and severe dysfunction, and severe tricuspid valve regurgitation was also observed. Despite optimal clinical treatment, improvement was not observed in the CHF or in the patient’s overall condition, which led to a change in the initial surgical treatment plan. A two-stage therapy was implemented, starting with a balloon mitral valvotomy as a bridge to surgery. The postoperative mitral valve area increased to 1.34 cm2. The patient showed significant clinical improvement, and a mitral valve replacement surgery was performed 120 days later with a mechanical valve and atrioseptoplasty using a bovine pericardial patch, as well as tricuspid valve cerclage. The patient was discharged 11 days after the surgery, and is currently in the sixth postoperative month. She continues to show clinical stability and improvements in her quality of life. DESCRIPTORS: Mitral valve stenosis. Lutembacher syndrome. Heart septal defects, atrial. Hypertension, pulmonary. Hospital Santa Izabel da Santa Casa de Misericórdia da Bahia – Salvador,