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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.
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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
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Prevalence and Hemodynamic Consequences of Mitral Valve Abnormalities in Atrial Septal Defect. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2022. [DOI: 10.5812/intjcardiovascpract-131707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Background: Atrial septal defect (ASD) is a common congenital heart disease in adults. Concomitant mitral valve disease in patients with ASD could have significant hemodynamic effects whit a great impact on managing this congenital defect. Objectives: This study evaluated the prevalence of mitral valve abnormalities and the hemodynamic burden associated with different types of ASD. Methods: This retrospective study reanalyzed 1,006 consecutive patients referred to Rajaie Heart Center in Tehran from March 2019 to February 2022. We evaluated adult patients with the diagnosis of a shunt at the atrial level. Diagnoses were made with 2D and 3D transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). 3D analysis was performed with 3D zoom, mitral valve navigation (MVN), and full-volume and multi-planar reconstruction (MPR) modalities. We performed statistical analysis by SPSS version 22.0. The qualitative data were expressed as frequency and percentage. Data were compared between subgroups via Mann-Whitney U/Kruskal-Wallis tests for the interval variables, Pearson's chi-square test for nominal variables, and chi-square for trends test for ordinal variables. Results: The distribution of different ASD types was ostium secundum in 88.8% of cases, primum ASD in 0.9%, SVC-type sinus venosus ASD in 9%, IVC-type sinus venosus in 0.4%, and unroofed coronary sinus in 0.9%. We found mitral valve abnormalities in 21.1% of cases, and the most common mitral valve abnormality were prolaptic lesions (17.4%). Conclusions: Age, ASD size, estimated Systolic Pulmonary Artery Pressure (SPAP), and severity of mitral regurgitation (MR) were markedly higher were markedly higher among patients with MV anomalies, more over left ventricular ejection fraction (LVEF) was significantly lower among this group (P-value < 0.05).
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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.
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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
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Phan QT, Nguyen HL, Le TD, Lee W, Won H, Shin S, Sharmin S, Nguyen TQ, Kim S. Combined Percutaneous Procedure in Patient with Lutembacher Syndrome: A Case Report and Real-World Experience Review. Cardiol Res 2019; 9:385-391. [PMID: 30627291 PMCID: PMC6306122 DOI: 10.14740/cr776w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/11/2018] [Indexed: 11/11/2022] Open
Abstract
Even cardiac surgery has been accepted as the standard therapy for Lutembacher syndrome, a combination of congenital ostium secundum atrial septal defect (ASD) and acquired mitral valve stenosis (MVS), it also owns many limitations and disadvantages. Therefore, seeking for a less invasive therapy with the same efficacy may be worthwhile. Thanks to the development in technology and experience gaining in cardiovascular intervention, the combination of the two proved effective procedures, including percutaneous MVS treatment using balloon valvuloplasty and percutaneous ASD closure using atrial septal occluders, can be utilized as an attractive alternative therapy for these conditions. Here, we present a successful percutaneous intervention in Lutembacher syndrome using the combination of mitral balloon valvuloplasty and ASD device closure and thoroughly review the experience of using this combined procedure existing in the literature.
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Affiliation(s)
- Quang Tan Phan
- Intervention Center, Quang Nam Central General Hospital, Quang Nam 562314, Vietnam.,Intervention Center, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Hieu Lan Nguyen
- Intervention Center, Vietnam National Heart Institute, Hanoi 115289, Vietnam
| | - Tai Duc Le
- Interventional Cardiology Department, Nghe An Province General Hospital, Nghe An, Vietnam
| | - WangSoo Lee
- Intervention Center, Chung-Ang University Hospital, Seoul 06973, Korea
| | - HoYoun Won
- Intervention Center, Chung-Ang University Hospital, Seoul 06973, Korea
| | - SeungYong Shin
- Intervention Center, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Saima Sharmin
- Intervention Center, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Truong Quang Nguyen
- Intervention Center, Quang Nam Central General Hospital, Quang Nam 562314, Vietnam
| | - SangWook Kim
- Intervention Center, Chung-Ang University Hospital, Seoul 06973, Korea
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Jain S, Dalvi B. Atrial septal defect with pulmonary hypertension: when/how can we consider closure? J Thorac Dis 2018; 10:S2890-S2898. [PMID: 30305949 DOI: 10.21037/jtd.2018.07.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients having atrial septal defect (ASD) with moderate and more importantly severe pulmonary arterial hypertension (PAH) pose a clinical dilemma. Closing ASD in those with irreversible PAH and not closing it when the PAH is reversible can cost patients dearly, both in terms of quality of life and longevity. In our experience, there is no single parameter that can help in decision making in this difficult subset of patients and therefore we recommend a multi-dimensional approach, which takes into consideration clinical, radiological, electrocardiographic and hemodynamic variables as a whole. ASD with restrictive left ventricular (LV) physiology can lead to pulmonary venous hypertension, which can manifest as life threatening acute pulmonary edema following device closure. All high-risk candidates prone to having this combination should be prepared with diuretics and vasodilators prior to bringing them to catheterization laboratory and should be assessed with temporary balloon/device occlusion prior to permanent closure of the defect. In those cases of ASD with borderline operability either due to severe PAH or LV restrictive physiology, perforated device may be helpful in preventing acute or long-term complications of complete closure.
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Affiliation(s)
- Shreepal Jain
- Department of Pediatric Cardiology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Glenmark Cardiac Center, Mumbai, Maharashtra, India
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Varsha AV, George G, Sahajanandan R. Lutembacher syndrome: Dilemma of doing a tricuspid annuloplasty. Ann Card Anaesth 2018; 20:456-458. [PMID: 28994686 PMCID: PMC5661320 DOI: 10.4103/aca.aca_36_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We discuss the case of a 24-year-old woman with Lutembacher syndrome and severe tricuspid regurgitation (TR) who underwent surgical closure of atrial septal defect and mitral valve replacement without tricuspid annuloplasty despite a severe TR and a large tricuspid annulus on preoperative echo. The pathophysiology of Lutembacher syndrome is discussed below. The utility of perioperative echocardiography in assessing the annular diameter, tenting area and coaptation depth and thus providing insights into the functioning of the tricuspid valve will also be emphasized.
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Affiliation(s)
- A V Varsha
- Department of Cardiothoracic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gladdy George
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Raj Sahajanandan
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
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