FUNCTIONAL MITRAL STENOSIS SEEN AFTER TRANS-JUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN A PATIENT WITH PRIOR HISTORY OF MITRAL VALVE REPAIR WITH ANNULOPLASTY RING

Abstract Background Rheumatic mitral valve (MV) disease is the major cause of congestive cardiac failure in children and young adults, particularly in developing countries. Mitral valve repair with minimum prosthetic material is the gold standard treatment for this condition. However, MV repair for rheumatic MV disease is known to be technically demanding. Case summary A 27-year-old woman without a history of cardiac disease presented with dyspnoea on exertion. Echocardiography revealed rheumatic severe mitral stenosis and regurgitation, with thickening of the bileaflets, doming of the anterior leaflet, shortening of the posterior leaflet, fusions of the lateral and particularly the medial commissure, and enlargement of the mitral annulus. We successfully performed robot-assisted MV repair with bicommissural release, patch augmentation of the two leaflets, and implantation of an originally sized partial band. Discussion Robotic MV repair can contribute to precise valve inspection and operative procedures. This approach seems feasible for complex rheumatic MV disease particularly in young patients.

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Early Period Mitral Stenosis After Mitral Annuloplasty: Functional or Real Stenosis?

10.21203/rs.3.rs-141458/v1 ◽

2021 ◽

Author(s):

Serkan Asil ◽

Veysel Özgür Barış ◽

Suat Görmel ◽

Murat Çelik ◽

Uygar Çağdaş Yüksel

Keyword(s):

Case Report ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Mitral Stenosis ◽

Early Period ◽

Valve Repair ◽

Mitral Valve Leaflet ◽

Annuloplasty Ring ◽

Mitral Annuloplasty

Abstract Background:Surgical repair of rheumatic mitral valve disease is technically more demanding however, mitral repair is preferred over mechanical valve implantation if possible. İn this case report we presented the case of functional mitral stenosis after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. Case Report:A 64-year-old female patient was admitted to our clinic with progressively worsening shortness of breath (New York Heart Association-Classification II-III), 6 months after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. The 28/13 mmHg gradient was observed in the mitral valve annuloplasty ring in transthoracic echocardiography. TEE findings showed that motions of the mitral valve leaflet were fine, but in the mitral annuloplasty ring there was an extreme constriction and increased gradient.Conclusion:The development of mitral stenosis following mitral valve surgery is a condition associated with multiple mechanisms that are poorly understood. Mitral valve repair can be difficult and low success rate, especially in rheumatic mitral valve patients. The defect in the surgical technique and the application of restrictive small annuloplasty causes an increased gradient, leading to the development of severe functional mitral stenosis, especially when accompanied by a slight increase in pannus tissue.

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