Page 28 - Journal of Structural Heart Disease Volume 4, Issue 3

Meeting Abstracts
Journal of Structural Heart Disease, June 2018, Volume 4, Issue 3:85-113
DOI: https://doi.org/10.12945/j.jshd.2018.006.18
Published online: June 2018
CSI Asia-Paci c
January 31 - February 3, 2018
1. PERCUTANEOUS TRANSLUMINAL MITRAL VALVULOPLASTY IN POST MITRAL VALVE REPAIR AND AORTIC VALVE REPLACEMENT PATIENT Chandra Mani Adhikari1, Rabi Malla1, Raamesh Koirala2, Dipanker Prajapati1, Navin Gautam2
1 Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
2 Department of Cardiovascular Surgery, Shahid Gangalal National Heart Centre Kathmandu, Nepal
A 34-year-old male, who underwent Aortic Valve replace- ment with mitral valve repair for rheumatic heart disease (RHD), Severe AR with moderate MR in 2007. Patient had NYHA class III Symptoms along with palpitation for 10 to 12 years. Hence he was taken for AVR and MV repair. Pre operation echo revealed RHD, Severe AR, Mod MR, Dilated LV (LVIDd/s 7.8/6.0cm), Dilated LA(4.3cm) and LVEF=55%. Intra-operative ndings revealed Dilated LA and LV, thickened aortic lea ets with lack of centre coaptation, Thickened AML and PLML with rolled edges, mild commis- sural fusion, mild to moderate sub-valvular changes. He underwent AVR with ATS 20mm and Bilateral commissur- otomy and papilotomy of P2, 27mmSJM ring angioplasty ring. Post repair no leak on saline test. Echocardiography after three month of surgery revealed Normally function- ing aortic prosthetic valve, Mitral valve area of 1.6cm2.
In March 2017, after 10 years of AVR and MV repair, patient presented with of extertional dyspnea. He underwent echocardiography which revealed normally functioning Aortic Valve (peak gradient across Aortic valve 15mmHg, Mean gradient =7mmHg), commissural fusion with MVA of 0.7cm2, as shown in Fig 3, no signi cant subvalvar pathology or calci cation of the valve, dilated LA. In view of suitable morphology of MV for percutaneous translumi- nal mitral valvuloplasty (PTMC) with Boston score (Wilkins
score) of 7, he was considered for PTMC. Heart team dis- cussion was done. Team decide to attempt PTMC so that MV replacement (MVR) may be delayed for few more years. IV heparin infusion was started and warfarin was stopped. Three hours before the procedure heparin was stopped. Three hour after the PTMC IV heparin was started and con- tinued until INR was in theurapeutic range.
Through right femoral vein approach patient underwent PTMC with 26mmAccura balloon in ated to 26mm.Pigtail catheter was not kept in the ascending aorta as the metal- lic Aortic valve was the landmark for the septal puncture. Procedure was successful with single in ation. Medial com- missure was split and lateral commissure was partially split.
1. Figure 1. Prosthetic Aortic valve with Mitral valve ring.
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