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Brain & Heart

CASE REPORT
Percutaneous management of Lutembacher’s

syndrome: A case report

1
Abhimanyu Uppal *, Rambabu Sharma , Gyarsi L. Sharma , and Ashok Garg 1
1
2
1 Department of Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
2 Department of Pediatrics, JK Lone Hospital, SMS Medical College, Jaipur, Rajasthan, India

Abstract

The definitive percutaneous management of Lutembacher’s syndrome (LS) is a
recognized alternative to surgery in selected cases. This intervention involves
balloon mitral valvuloplasty (BMV) followed by device closure of the atrial septal
defect (ASD). However, despite its recognition, certain challenges inherent to the
procedure have not been highlighted in the majority of earlier case reports. The
subject of the present case is a 30-year-old male diagnosed with LS who underwent
definitive percutaneous treatment. The coexisting ASD required improvisation
to facilitate balloon insertion across the mitral valve using the modified Inoue
technique. Furthermore, the ASD device was deliberately oversized to prevent
device embolization. This case highlights that percutaneous management of LS is
not merely a combination of BMV and device closure procedures. Instead, the unique
anatomic and hemodynamic features of LS should be considered when formulating
treatment strategies for these patients.

*Corresponding author: Keywords: Atrial septal defect; Mitral stenosis; Modified Inoue technique; Balloon
Abhimanyu Uppal
(jaipurheartinstitute@gmail.com) manipulation
Citation: Uppal A, Sharma R,
Sharma GL, Garg A. Percutaneous
management of Lutembacher’s
syndrome: A case report. Brain & 1. Background
Heart. 2024;2(1):1701.
https://doi.org/10.36922/bh.1701 The most common variant of Lutembacher’s syndrome (LS), characterized by the
Received: August 28, 2023 combination of a congenital atrial septal defect (ASD) and acquired mitral stenosis (MS),
has conventionally been treated through surgical intervention. However, over the past
1
Accepted: November 15, 2023
three decades, a notable shift has occurred, as evidenced by several reports advocating
Published Online: February 6, 2024 for percutaneous management. This approach involves percutaneous balloon mitral
2-4
Copyright: © 2024 Author(s). valvuloplasty (BMV) followed by ASD device closure, presenting itself as a seemingly
This is an Open-Access article simple and effective alternative.
distributed under the terms of the
Creative Commons Attribution The potential omission of the inter-atrial septal puncture step, facilitated by the
License, permitting distribution, presence of a concomitant ASD, may create the impression of a simplified procedure
and reproduction in any medium,
provided the original work is compared to conventional BMV. However, counterintuitively, the treatment of LS is more
properly cited. than just a combination of BMV and ASD device closure procedures. Recent reports
Publisher’s Note: AccScience underscore the unique anatomic and hemodynamic challenges faced by interventionalists
Publishing remains neutral with in such scenarios, often requiring on-table improvisation of conventional techniques.
5,6
regard to jurisdictional claims in
published maps and institutional The current case report contributes to this body of knowledge by highlighting the unique
affiliations. challenges encountered when treating a young patient with LS.

Volume 2 Issue 1 (2024) 1 https://doi.org/10.36922/bh.1701