Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway and Atrial Flutter: A Case Report

A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had higher refractory period than atrioventricular node.

Anterior Mitral Leaflet Tear during Balloon Mitral Valvotomy in a Case of Juvenile Mitral Restenosis

Recurrent attacks of rheumatic fever can lead to mitral stenosis. In a country like India mitral stenosis can develop in the first decade of life. Our patient presented with recurrent mitral stenosis at twelve years of age. He had undergone balloon mitral valvotomy at the age of seven. However this time he developed anterior mitral valve leaflet tear after balloon mitral valvotomy and had to be taken for mitral valve repair. Due to severe fibrosis of mitral valve the patient underwent mitral valve replacement. He was started on warfarin and dose titrated according to PT / INR. Patient was discharged but has to be on lifelong anticoagulation from the age of twelve.