1
|
Khattab MN, Alhalabi MM, Alkounsol K, Othman M, Hujair N. Lutembacher's Syndrome Accompanied by Partial Anomalies of Pulmonary Veins in a 70-Year-Old Male: A Case of Congenital Heart Disease in the Elderly. Eur J Case Rep Intern Med 2023; 10:004089. [PMID: 37920223 PMCID: PMC10619523 DOI: 10.12890/2023_004089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 11/04/2023] Open
Abstract
Lutembacher's syndrome is a rare disease defined as the combination of atrial septal defect and mitral stenosis, which relieves the progression of symptoms resulting from mitral stenosis. We present a case of a previously asymptomatic 70-year-old man having Lutembacher's syndrome with sinus venosus type of interatrial defect associated with partial anomalous pulmonary venous drainage. Our patient's only complaint was of mild exertional dyspnea, which started six months prior to referral. Clinical suspicion of the combination of defects arose during transthoracic echocardiography. The patient underwent transesophageal echocardiography and multi-slice computed tomography for defect confirmation. The combination of Lutembacher's syndrome with this complex deformity of pulmonary venous drainage has rarely been described. Such complex congenital defects with multifaceted physiological repercussions can go largely undiagnosed for the patients affected for most of their lifetimes. LEARNING POINTS Despite the complexity of Lutembacher's syndrome, including the involvement of several deformities and pathological mechanisms of mitral stenosis, sinus venosus type of interatrial defects with partial anomalous return in the pulmonary veins, the multiplicity of mechanisms involved contribute to altered hemodynamics.Multiple intersecting mechanisms can further contribute to delaying congenital heart disease presentation. Congenital heart disease remains a plausible differential in the evaluation of elderly patients presenting with exertional dyspnea.Adult congenital heart defects can have very late onset for presentation, especially with physiological processes that paradoxically reduce the severity and progression of symptoms.
Collapse
Affiliation(s)
| | | | - Karam Alkounsol
- Department of Cardiology, Al Bassel Heart institute, Damascus, Syria
| | - Majed Othman
- Department of Cardiac Surgery, Al Bassel Heart institute, Damascus, Syria
| | - Nizar Hujair
- Department of Cardiology, Al Bassel Heart institute, Damascus, Syria
| |
Collapse
|
2
|
Yadav R, Sharma A, Pathak S. A Case Series on Successful Surgical Management of Patients Presenting With Lutembacher's Syndrome to a Tertiary Healthcare Center in Northern India. Cureus 2023; 15:e44371. [PMID: 37779792 PMCID: PMC10540655 DOI: 10.7759/cureus.44371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Atrial septal defect (ASD), whether congenital or iatrogenic, and mitral stenosis (MS), whether congenital or acquired, may all come together into a condition called Lutembacher's syndrome (LS). The ASD is typically larger than 15 mm in a normal LS case. However, congenital ASD is less frequent than residual iatrogenic ASD in the current era of percutaneous balloon mitral valvuloplasty for acquired MS. This is referred to as iatrogenic LS by cardiologists. Hereby, we report a case series of three patients who presented to us, were diagnosed with LS, a very rare entity, and were managed successfully.
Collapse
Affiliation(s)
- Rajeshwar Yadav
- Department of Cardiothoracic & Vascular Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Swati Pathak
- Department of Cardiothoracic & Vascular Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| |
Collapse
|
3
|
Adu‐Boakye Y, Amponsah GM, Andoh HK, Gyan KF, Wiafe YA. Lutembacher syndrome in a middle-aged woman in Ghana with an extremely large atrial septal defect. Clin Case Rep 2023; 11:e6939. [PMID: 36789326 PMCID: PMC9913180 DOI: 10.1002/ccr3.6939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 02/12/2023] Open
Abstract
Lutembacher syndrome (LS) is a rare heart disorder characterized by a congenital or acquired combination of the atrial septal defect (ASD) and mitral stenosis. In LS, patients may be asymptomatic for years, but early detection and treatment result in a better prognosis. In contrast, the prognosis is usually poor, with conservative treatment if the diagnosis is late and the patient develops heart failure and pulmonary hypertension. Although rheumatic heart disease (RHD) and congenital heart disease are prevalent in Ghana, cases of LS are not reported. Here, we report the case of a 45-year-old woman with rheumatic mitral valve stenosis and an exceptionally large ASD with bidirectional flow who was diagnosed with LS and treated conservatively for heart failure at a cardiology clinic in Ghana.
Collapse
Affiliation(s)
- Yaw Adu‐Boakye
- Department of MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana
| | - Gordon Manu Amponsah
- Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana,Department of PhysiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | | | - Yaw Amo Wiafe
- Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana,Department of Medical DiagnosticsKwame Nkrumah University of Science and TechnologyKumasiGhana
| |
Collapse
|
4
|
Muacevic A, Adler JR, Tara N, Anwar M, Khan MU. A Rare Case of Severe Isolated Right Heart Failure with Secundum Type Atrial Septal Defect and Mitral Regurgitation Without Pulmonary Hypertension. Cureus 2023; 15:e34112. [PMID: 36843826 PMCID: PMC9946817 DOI: 10.7759/cureus.34112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Typically, right heart failure (RHF) may occur following left heart failure (LHF) in chronic volume overload states such as chronic severe mitral regurgitation (MR) through chronically elevated pulmonary pressures. In Lutembacher syndrome (LS), the direct shunting through a secundum type atrial septal defect (ASD) results in congestive heart failure in the setting of severe mitral stenosis (MS) with or without elevated pulmonary arterial or venous pressures. We report a rare case of severe isolated RHF and bi-atrial enlargement resulting from the direct shunting through a secundum type ASD in the presence of a severe eccentric primary MR. There are no significant cases documented like this after a thorough search using PubMed, Medline, and Google Scholar. A review of the literature suggests that LS is also caused by a combination of mitral regurgitation and a secundum-type atrial septal defect without mitral stenosis, though rarely. Because this is a primary MR, we feel it is a case of LS with MR, ruling out a combination of secondary MR and secundum-type atrial septal defect.
Collapse
|
5
|
Yang Z, Kang Y, Wei J. Rapid progression of mitral stenosis after atrial septal defect closure in a Lutembacher's syndrome patient. J Card Surg 2022; 37:1066-1068. [PMID: 35060199 DOI: 10.1111/jocs.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Zixuan Yang
- Department of Cardiology, West China Hospital Sichuan University Chengdu Sichuan China
| | - Yu Kang
- Department of Cardiology, West China Hospital Sichuan University Chengdu Sichuan China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital Sichuan University Chengdu Sichuan China
| |
Collapse
|
6
|
Pomerantzeff PM, Bichuette LD, Veronese ET, Rodrigues RC, Spina GS, Jatene FB. Total surgical correction of Lutembacher syndrome associated with partial anomalous connection of the pulmonary veins and tricuspid regurgitation. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:499-503. [PMID: 34548950 PMCID: PMC8449200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
Lutembacher syndrome is characterized by the association of mitral stenosis and atrial septal defect (ASD), usually of the ostium secundum type. The association between superior vena cava-type ASD and partial anomalous pulmonary venous connection is unusual and there are few descriptions in the literature. We report this condition in a 24-year-old woman who was admitted to the hospital with a 1-year history of progressive dyspnea and describe the successful surgical repair following mitral commissurotomy and tunneling of the anomalous pulmonary veins to the left atrium, which determines the closure of the ASD and tricuspid repair.
Collapse
Affiliation(s)
- Pablo Ma Pomerantzeff
- Instituto do Coração, do Hospital das Clínicas, da Faculdade de Medicina, da Universidade de São Paulo Brazil
| | - Luciana D Bichuette
- Instituto do Coração, do Hospital das Clínicas, da Faculdade de Medicina, da Universidade de São Paulo Brazil
| | - Elinthon T Veronese
- Instituto do Coração, do Hospital das Clínicas, da Faculdade de Medicina, da Universidade de São Paulo Brazil
| | - Renan C Rodrigues
- Instituto do Coração, do Hospital das Clínicas, da Faculdade de Medicina, da Universidade de São Paulo Brazil
| | - Guilherme S Spina
- Instituto do Coração, do Hospital das Clínicas, da Faculdade de Medicina, da Universidade de São Paulo Brazil
| | - Fabio B Jatene
- Instituto do Coração, do Hospital das Clínicas, da Faculdade de Medicina, da Universidade de São Paulo Brazil
| |
Collapse
|
7
|
An Incidental Diagnosis of Rheumatic Mitral Stenosis and Secundum Atrial Septal Defect (Lutembacher's Syndrome) in a Young Woman. Case Rep Cardiol 2019; 2019:9402987. [PMID: 31781405 PMCID: PMC6875355 DOI: 10.1155/2019/9402987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022] Open
Abstract
Lutembacher's syndrome is a rare cardiovascular defect comprising of mitral stenosis and atrial septal defect. A combination of acquired mitral stenosis and congenital atrial septal defect is the most well-recognized pattern. As atrial septal defect acts as a pressure relieving gateway, signs and symptoms of mitral stenosis may be attenuated and/or delayed in such patients. We have presented a case with Lutembacher's syndrome that was incidentally diagnosed as having such defect during outpatient check-up for upper respiratory infection.
Collapse
|
8
|
Vodusek Z, Khaliqdina S, Borz-Baba C, Scandrett R. Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis. Cureus 2019; 11:e5936. [PMID: 31788393 PMCID: PMC6858266 DOI: 10.7759/cureus.5936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sinus venosus atrial septal defect (SVASD) is a rare adult congenital heart disease which permits shunting of blood from the systemic to the pulmonary circulation and is commonly associated with anomalous pulmonary venous return. We report a case of a 27-year-old man with a history of premature birth and unilateral cryptorchidism who was admitted for syncope. Electrocardiogram (ECG) demonstrated atrial fibrillation (AF)and S1Q3T3 pattern along with an incomplete right bundle branch block. Transthoracic echocardiography (TTE) suggested the presence of right ventricular pressure and volume overload and severe right ventricular and right atrial enlargement. The agitated saline study was negative suggesting no inter-atrial communication. Transesophageal echocardiography (TEE) demonstrated a superior SVASD and raised the possibility of an anomalous pulmonary venous connection. Chest computed tomography identified the right superior pulmonary vein connection to the superior vena cava. The diagnosis of SVASD poses multiple challenges from the variety of symptoms to the selection of appropriate imaging and the complexity of surgical treatment.
Collapse
Affiliation(s)
- Ziga Vodusek
- Internal Medicine, Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, USA
| | | | | | | |
Collapse
|
9
|
Kale SB, Punithakumar R, Senthilkumar R. Sinus venosus atrial septal defect with severe mitral stenosis: a rare variant of Lutembacher's syndrome. Indian J Thorac Cardiovasc Surg 2018; 34:516-518. [PMID: 33060929 DOI: 10.1007/s12055-018-0677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022] Open
Abstract
Lutembacher's syndrome refers to the rare combination of congenital atrial septal defect, usually secundum type and acquired mitral stenosis. However, the presence of sinus venosus atrial septal defect along with severe mitral stenosis and severe pulmonary hypertension is rarely seen, and this article reports on this rarity with its management.
Collapse
Affiliation(s)
- Suresh Babu Kale
- Department of Cardiovascular Thoracic Surgery, Meenakshi Hospital, Trichy Road, Tanjore, Tamil Nadu State 613005 India
| | - Ramasamy Punithakumar
- Department of Cardiovascular Thoracic Surgery, Meenakshi Hospital, Trichy Road, Tanjore, Tamil Nadu State 613005 India
| | - Ramalingam Senthilkumar
- Department of Cardiovascular Thoracic Surgery, Meenakshi Hospital, Trichy Road, Tanjore, Tamil Nadu State 613005 India
| |
Collapse
|