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Objectives: To determine frequency of LA clot resolution in patients with severe MS after three months of anticoagulation. Methodology: A descriptive study was conducted over 6 months from Jul 2018 to Jan 2019 including 49 patients who fulfilled the inclusion criteria and visited Cardiology department, NICVD Hospital-Karachi. After clinical evaluation, warfarin therapy was given for 3 months followed by Transesophageal echocardiography (TEE) to access the resolution of LA thrombus. Chi-square test and Fisher Exact test were used to assess the effect of patient characteristics and echocardiographic findings on the resolution of thrombus. Results: The mean age of the study patients was 47.51±9.93 years. The average mitral valve area (cm2) was observed to be 0.68±0.16, while the average size of left atrial (mm) was 54.38±7.19. At the end of 2 months, TEE showed successful resolution of clot in 11 (22.4%). While by the end of 3 months, only 6 (12.2%) patients showed successful resolution of clot. Conclusion: After 3 months of oral anticoagulation, the LA thrombus resolved in almost 1/4th of the study patients. Successful clot resolution showed positive correlation with history of stroke, hemoptysis and clot mobility and negative correlation with severity of tricuspid regurgitation. [ABSTRACT FROM AUTHOR]

Background: Among cardiac causes for postpartum maternal collapse, severe mitral stenosis is not listed as a potential cause in current literature. We report a rare case of severe mitral stenosis that presented with severe hypoxia and maternal decompensation in early postpartum period for the first time. A 30-year-old para 2, abortus 1, Ethiopian woman developed severe hypoxia and rapid deterioration on her sixth postoperative day after cesarean delivery for fetal bradycardia with a good fetal outcome. She was put on a mechanical ventilator when she developed respiratory failure. Initially, a diagnosis of pulmonary embolus was considered. After admission to the intensive care unit, severe mitral stenosis was diagnosed with the help of echocardiography. She was managed successfully for congestive heart failure and discharged from the intensive care unit with improvement.Conclusion: The possibility of mitral stenosis, as a differential diagnosis, should be considered whenever a case of postpartum maternal collapse is encountered. We recommend a routine immediate echocardiography in any patient that experiences postpartum collapse, especially in the presence of a known trigger for heart failure such as long hours of labor, bleeding, anemia, hypotension, and infection. [ABSTRACT FROM AUTHOR]

Background: Percutaneous balloon mitral valvuloplasty (BMV) is reasonable management for inoperable patients with severe symptomatic mitral stenosis (MS) and favorable patient/anatomic characteristics1. However, the presence of adverse features such as annular calcification is associated with unpredictable outcomes in this challenging population. Compassionate utilization of BMV in inoperable patients is increasing worldwide and represents salvage management. Case report: A middle-aged patient with a history of stroke, diabetes, anemia, and bipolar disorder was repeatedly admitted due to severe dyspnea. Initial work-up showed a preserved left ventricular function with a severe degenerative MS (mean gradient 12-15 mmHg and area <1.1 cm2), mild commissural fusion and moderate medial annular calcification (Cormier score 3) (Figure 1). Right heart catheterization (RHC) showed high pulmonary artery (43 mmHg) and wedge (18 mmHg) pressures with high pulmonary vascular resistance (PVR, 8.4 WU). The patient was referred to cardiac surgery, but it was deemed as a prohibitive surgical risk. Due to refractory heart failure with multiple short-term rehospitalizations, the patient was proceeded to salvage BMV. Procedural details: The transseptal (TS) access and balloon septostomy (NyloTrack® 7x40mm) were done. Thereafter, a successful BMV procedure was performed (Edwards® 23x40mm, Z-Med® 25x40mm) (Figure 2). Early postprocedural echocardiogram detected better hemodynamic parameters with residual severe MS (mean gradient ~8 mmHg and area ~1.4 cm2). The patient was successfully discharged. Follow-up: Novel readmission occurred in a short period due to the recurrence of symptoms. Repeated imaging and RHC showed improved determinants of pulmonary hypertension and PVR. The patient was again referred to surgeons, but this time she was accepted for operation due to a better risk profile. Conclusions: Percutaneous BMV is an optional salvage procedure for inoperable patients with severe refractory MS and unfavorable characteristics. Its utilization should be reserved for palliative symptomatic relief with uncertain long-term hemodynamic effects. Some patients may benefit from surgical risk reduction and bridge to surgery. [ABSTRACT FROM AUTHOR]

Mitral stenosis (MS) is the most common valvular heart disease associated with pregnancy. The increase in cardiac output during pregnancy results in deterioration of the patient's condition with progress to higher New York Heart Association class. Both general and regional anesthesias have been described for cesarean section in these patients. Anesthetic management of these patients depends upon the severity of the disease. General anesthesia has traditionally been preferred for cesarean section in patients with severe MS. Regional anesthesia has become popular as a safe choice in the recent past for cesarean section in all parturients including those with heart disease. We report three parturients with severe MS who underwent cesarean delivery under graded epidural block successfully. The parturients and the neonates were fine after the procedure. [ABSTRACT FROM AUTHOR]

Even though, the incidence of Mitral Stenosis (MS) has reduced grossly, it still remains a health problem in developing countries and is the most common rheumatic valvular lesion encountered in pregnant patients. The already compromised cardiac status of a pregnant female deteriorates further by the presence of MS. So, pregnancy is a common situation during which untreated and frequently poorly tolerated MS are first diagnosed. Percutaneous Balloon Mitral Valvuloplasty (BMV) may be life saving in such a setting and a multidisciplinary approach in the management reduces the mortality and morbidity during the procedure. Anaesthetic management of such a procedure has hardly ever been reported. We report a case of a 23-year-old woman presenting at 28 weeks gestation with severe MS and severe pulmonary hypertension 52 mmHg who underwent successful percutaneous BMV under monitored anaesthesia Care. The anaesthetic considerations in such situations are being discussed. [ABSTRACT FROM AUTHOR]

A 46‐year‐old male with known rheumatic heart disease presented in cardiac arrest. He was successfully resuscitated. Two‐dimensional echocardiography showed severe calcific rheumatic mitral stenosis with pinhole opening of the valve. The mitral valve area in planimetry was 0.14 cm2. Three‐dimensional echocardiography confirmed the severity of the stenosis. Patient underwent successful mitral valve replacement with tricuspid valve annuloplasty, Left atrial size reduction, and maze procedure on emergency basis. A mitral valve area of 0.14 cm2 is rarely encountered in clinical practice. [ABSTRACT FROM AUTHOR]