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Brain & Heart Lutembacher’s percutaneous treatment

A B

C

Figure 3. (A) Continuous Doppler tracing across MV post-BMV; (B) Peak RV systolic pressure post-procedure as estimated from the peak of TR
velocity jet; (C) ASD device in situ at 3 months of follow-up.
Abbreviations: ASD: Atrial septal defect; BMV: Balloon mitral valvuloplasty; MV: Mitral valve; RV: Right ventricle; TR: Tricuspid regurgitation.

technique, and retrograde balloon insertion through apparent ease of performing BMV and ASD device closure
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the arterial approach. We employed the modified Inoue in contemporary practice should not overshadow the
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technique to achieve an optimal BMV result by leveraging unique challenges faced when combining these procedures
our available hardware and the previous experience in in a patient with LS. Thorough pre-procedure planning,
treating such cases. an in-depth understanding of the various balloon
manipulation techniques to cross the MV, and precise sizing
In the presence of good TTE images and ASD sizes
<20 mm in diameter, we usually avoid trans-esophageal of the device for ASD closure are paramount. Neglecting
imaging during ASD closure, as was done in this case. As these considerations may lead to potential catastrophes
6
previously suggested by Bagga et al., we usually oversize due to the underestimation of procedure difficulty.
the ASD occluder by at least 4 mm (instead of the routinely Acknowledgments
used 2 mm) in LS as the LA pressure is higher with
co-existing MS and predisposes to device embolization. None.
The above case report, along with the previous Funding
publications, suggests that definitive percutaneous
treatment in carefully selected LS cases is safe and effective, None.
thereby reducing mortality and morbidity risks associated Conflict of interest
with cardiac surgery. Percutaneous treatment also
decreases the physiologic trauma due to the thoracotomy The authors declare that they have no competing interests.
scar and the length of hospital stay. At the same time, the
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unique hemodynamic and anatomic aspects of co-existing Author contributions
MS and ASD should be given due consideration while Conceptualization: Abhimanyu Uppal, Rambabu Sharma
planning definitive percutaneous intervention for these Investigation: Gyarsi L. Sharma, Ashok Garg
cases. Writing – original draft: Abhimanyu Uppal
Writing – review & drafting: Rambabu Sharma, Ashok Garg
4. Conclusion
Ethics approval and consent to participate
The adage “one plus one perhaps does not equal two”
applies to the percutaneous management of LS. The Not applicable.

Volume 2 Issue 1 (2024) 4 https://doi.org/10.36922/bh.1701