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Emergency Closed Mitral Valvotomy with Transesophageal Echocardiographic Guidance

Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India

For reprint information contact: Harkant Singh, MCh Tel: 91 981 507 5294 Email: baryah{at}gmail.com, Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Sciences and Research, Sector 12, Chandigarh 160012, India.

A 25-year-old patient with mitral stenosis presented in acute pulmonary odema after a failed balloon mitral valvotomy. She underwent a successful emergency closed mitral valvotomy (CMV) through a quick limited anterolateral thoracotomy with cardiopulmonary bypass on standby.

The old procedure of CMV has largely been given up now in favour of safer procedures like open mitral valvotomy and mitral replacement on cardiopulmonary bypass. The technique has made a resurgence under transesophageal echocardiographic (TEE) guidance through a limited anterolateral thoracotomy in selected patients of pure mitral stenosis. The advantages of the technique in gestational acute pulmonary odema of mitral origin are a quick procedure and avoidance of cardiopulmonary bypass. Balloon mitral valvotomy remains the procedure of choice. Closed mitral valvotomy with TEE guidance provides a greater element of safety and immediate evaluation of the valve status. Seen here is the surgeon’s right index finger in the left atrium and the corrosponding continuous mode spectral waveform (Figure 1) and the transventricular Tubb’s dilator through the mitral valve (Figure 2).

View larger version (81K): [in this window] [in a new window]   Figure 1. Finger in the LA and continuous mode recording showing a valve area of 2.2 cm2 and minimal postprocedure MR (white arrow on the finger, LA = left atrium, LV = left ventricle, RV = right ventricle, MV = mitral valve).

View larger version (78K): [in this window] [in a new window]   Figure 2. Transventricular Tubb’s dilator through the mitral valve (white arrow shows the tip of the dilator in the left atrium).

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Suvitesh Luthra Harkant Singh Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dhaliwal, R. S. Articles by Singh, H. Search for Related Content PubMed PubMed Citation Articles by Dhaliwal, R. S. Articles by Singh, H.