Emergency surgery after percutaneous transmitral commissurotomy: Operative versus echocardiographic findings, mechanisms of complications, and outcomes

Abstract

Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology.

Percutaneous Transmitral Commissurotomy (Ptmc); Procedural Success and Immediate Results, a Tertiary Care Hospital Experience From Developing Country

“…24 Our results showed that 20(16.12%) got mild MR, 2(1.6%) had moderate MR and 4(2.173%) severe MR and these results coincide with other studies. Significant MR is defined as MR of ≥2/4 grade.…”

Successful balloon mitral valvotomy in a rare coexistence of Ebstein's anomaly and rheumatic mitral stenosis

“…This increases the chances of a high septal puncture with attendant risk of haemopericardium and cardiac tamponade. Transoesophageal echocardiography (TOE) can be helpful in avoiding this complication 13. A very large right atrium may not allow adequate tenting of the interatrial septum for the needle to enter the LA.…”

Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: Pathophysiology of hemodynamic collapse and peri-operative management issues

“…[3,4,5,6] The extensively fused and thickened subvalvar structures and calcium in the commissures are unyielding sites of greater resistance leading to persistent MS. The PAH of the unrelieved MS is acutely worsened by severe MR.…”

“…The patients with severe MR as defined by a Doppler color flow mapping of regurgitant jet-to-left atrial (LA) area ratio of 76-100% usually require emergency MVR. [5] Acute severe (gradient 24/13 mmHg), MV area of 0.6 cm 2 , mild MR, large LA with no clots, mild tricuspid regurgitation (TR), moderate pulmonary arterial hypertension (PAH), right ventricular (RV) internal diameter (ID) 12 mm and left ventricular (LV) ejection fraction (EF) 52%. The MV lateral commissure was fused and the patient was taken up for BMV.…”