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Rheumatic mitral stenosis is the most common organic valvular heart disease in developing countries. These patients are at risk of decompensation during pregnancy. We here describe our experience with percutaneous dilation of mitral stenosis in patients with severe pulmonary hypertension during pregnancy. Percutaneous balloon mitral valve commissurotomy was performed in two hundred and twenty-three pregnant women between January 2009 and December 2015. Forty-three (19%) of these patients had severe pulmonary hypertension (SPAP > 70 mmHg). All pregnant women in our study had very severe symptomatic rheumatic mitral stenosis despite well-performed medical treatment. All patients had clinical improvement after percutaneous balloon mitral valve commissurotomy. The severity of mitral insufficiency progressed by one grade in two patients. One patient had tamponade with favorable outcome after a pericardial puncture. No abortion occurred after the procedure and two preterm deliveries were reported. Patients with severe rheumatic mitral stenosis during pregnancy should receive multidisciplinary care involving an obstetrician, anesthetist and cardiologist. Percutaneous balloon mitral valve commissurotomy is currently the standard treatment for rheumatic mitral stenosis during pregnancy. [ABSTRACT FROM AUTHOR]

Atrial myxoma is a rare and benign clinical entity. It remains common in women and mainly affects the left atrium. Its clinical picture is polymorphic. We report the case of a 53-year-old woman who consulted for dyspnea with cardiac failure's picture. The diagnosis of myxoma of the left atrium was made on echocardiography which also objectified the existence of mitral stenosis. The patient underwent surgical excision and mitral valve replacement with good postoperative outcomes., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Shone syndrome is a rare and complex congenital heart disease. It is characterized in its complete form, by a constellation of the four potentially obstructive lesions of the left heart side. Incomplete Shone's complex includes 2 or 3 of the characteristic lesions which, include a supravalvular mitral membrane, valvular mitral stenosis (MS) by a parachute mitral valve (PMV), subaortic stenosis and aortic coarctation (Coa). We describe here, the case of a 35-year-old man, hospitalized for chronic dyspnea and in whom, the diagnosis of incomplete Shone's complex is retained by echocardiographic analysis. Observed lesions include a parachute mitral valve responsible for mild regurgitation and moderate mitral stenosis, bicuspid aortic valve, and pseudo interruption of the aorta with dilatation of the ascending aorta and a patent ductus arteriosus. This case is the 2nd on 3942 patients in Drighil congenital heart disease registry., Competing Interests: Conflits d'intérêts Les auteurs déclarent ne pas avoir de conflit d'intérêts., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé Introduction La prise en charge des valvulopathies mitrales pendant la grossesse continue à poser un défi au médecin. Objectif Le but de cette étude était d’évaluer les conséquences du rétrécissement mitral sur la mère et le fœtus. Matériel et méthodes Quatre-vingt-trois patientes atteintes d’un rétrécissement mitral (RM) ont été suivies de manière prospective de 2009 à 2012 et évaluées par le stade de la NYHA, l’ECG et l’échocardiographie durant la grossesse et après la délivrance. Résultats Les patientes avaient une forte incidence de complications, l’aggravation du stade de la NYHA a été observée (44,57 %, p = 0,0001), l’insuffisance cardiaque congestive a été retrouvée (27,71 %, p = 0,0001), l’hospitalisation (33,73 %, p = 0,0001), le recours au traitement médical spécifique (53,75 %, p = 0,009), les troubles du rythme (16 %, p < 0,05). Le RM avait ainsi un retentissement sur le nouveau-né, on a eu un taux élevé de prématurité (17,50 %, p = 0,018) une hypotrophie (20,48 %, p = 0,001), le retard de croissance intra-utérine (12,04 %, p = 0,011) ; l’hospitalisation en unité de néonatologie (13,25 %, p = 0,03). Conclusion Le RM serré constitue un groupe à haut risque de complications, un suivi rigoureux doit être exercé pendant la grossesse avec une surveillance du fœtus, la correction de valvulopathie doit être effectuée avant la conception. Introduction The management of pregnancy in patients with mitral valve stenosis disease continues to pose a challenge to the clinician. Objective The aim of study was to evaluate the association between mitral valve stenosis and maternal and fetal out come. Materiel and method Eighty-three pregnant women with mitral valve disease, followed-up from 2009 to 2012, were prospectively evaluated medical history, NYHA class assessment, ECG and echocardiography were performed during pregnancy and after delivery. Results Women with mitral stenosis had significantly clinical higher incidence of complications deterioration of clinical status was observed (44.57%, P = 0.0001) congestive heart failure had observed (27.71%, P = 0.0001), hospitalization (33.73%, P = 0.0001), need of cardiac medications (53.75%, P = 0.009), arrhythmias (16%, P < 0.05), New born outcome, mitral stenosis had an effect on fetal outcome. We had increasing preterm, delivery (17.50%, P = 0.018), hypotrophy (20.48%, P = 0.001), intra-uterine growth retardation (12.04%, P = 0.011) new born hospitalizations (13.25%, P = 0.03) Increased maternal morbidity and unfavorable fetal outcome was seen mostly in patients with moderate and severe mitral stenosis. Conclusion Pregnant with critical mitral stenosis form a high-risk groups of life-threatening complications. There is need for close maternal follow-up and fetal surveillance and repair of mitral stenosis should be performed before pregnancy. [ABSTRACT FROM AUTHOR]

Pregnant women with severe mitral stenosis tend to experience clinical decompensation with approximately 50% mortality and they may experience adverse effects of the medication they are taking, notably congenital malformations from warfarin exposure. Corrective heart surgery may increase the risk of pregnancy loss. We present 2 cases of RHD in pregnancy. The first case was a 27-year-old patient in her first pregnancy with severe mitral stenosis. Caesarean section was done for foetal distress and she delivered a small for gestational age baby. She was closely monitored postpartum and was stable on discharge. She presented with supraventricular tachycardia and died in the coronary care unit 4 weeks postpartum. The second case was a 28-year-old who was on warfarin for a mechanical mitral valve. A foetal anomaly scan done at 20 weeks showed severe congenital malformations which were not compatible with extra-uterine life. The pregnancy was terminated and she recovered well. The first case illustrates the significant mortality risk with uncorrected severe rheumatic heart disease. The second case highlights the risks of warfarin on the foetus and the need to avoid mechanical heart valves if possible in young women. RHD patients require preconception counselling so they can make informed reproductive choices.

From heart disease complicating pregnancy, rheumatic mitral stenosis occupies a larger part. Physiological changes during pregnancy and the impact of pathological mitral stenosis on pregnancy and labor are important to know. A multidisciplinary approach to the diagnosis and treatment reduces mortality and morbidity. We report the case of a patient with mitral stenosis moderately tight with term pregnancy and perioperative management.

Résumé: Le syndrome de Lutembacher associe une communication interauriculaire (CIA) congénitale et un rétrécissement mitral (RM). Il est rarement associé à un retour veineux pulmonaire anormal (RVPA) partiel qui dilate encore plus l’oreillette droite. Cette condition relève d’un traitement chirurgical de commissurotomie mitrale ou de remplacement valvulaire mitral, fermeture de la communication interauriculaire avec correction du retour veineux. La dilatation mitrale percutanée préalable à la chirurgie peut être une alternative thérapeutique si le rétrécissement mitral est serré et l’état anatomique valvulaire favorable. Les auteurs rapportent le cas d’un patient âgé de 24ans ayant un rétrécissement mitral serré en rythme sinusal avec une communication interauriculaire type sinus venosus et un retour veineux pulmonaire anormal partiel. Le diagnostic a été fait à l’âge de 17ans à l’occasion d’une dyspnée. Il a bénéficié en février 2003 d’une dilatation mitrale percutanée de sauvetage au décours d’un œdème aigu du poumon. La surface mitrale est passée de 0,7 cm2 à 1,6 cm2. Devant l’amélioration clinique ultérieure, le patient a refusé la chirurgie réparatrice et a été perdu de vue. Sept ans plus tard (août 2010), il a été repris pour une deuxième dilatation mitrale de sauvetage en raison d’une resténose mitrale très serrée (surface mitrale à 0,8 cm2), en subœdème pulmonaire avec une hypertension artérielle pulmonaire échocardiographique à 68mmHg. Le trans-septal s’est compliqué d’une fausse route à partir de l’oreillette droite, vers la cavité péricardique. Le patient a été opéré en urgence et a alors bénéficié d’un remplacement valvulaire mitral par prothèse mécanique, d’une fermeture de la CIA type sinus venosus par un patch de PTFE et correction du retour veineux. Les suites opératoires ont été simples et l’échocardiographie postopératoire met en évidence un bon profil de la prothèse, l’absence de shunt résiduel et une diminution de la pression artérielle pulmonaire qui est passée de 68 à 40mmHg. En conclusion, la dilatation mitrale percutanée peut être un geste d’attente de la chirurgie réparatrice de cette pathologie ou un traitement d’urgence de sa valvulopathie, moyennant un suivi régulier dans l’attente d’une chirurgie rapide et dans les meilleures conditions. [ABSTRACT FROM AUTHOR]

Rheumatic heart disease continues to contribute greatly to the burden of cardiovascular disease in Sub-Saharan Africa despite advances in medical care. Evidence suggests that the prevalence is far greater than reported. There is therefore the need to emphasize routine screening for at-risk subjects and to appropriately institute adequate therapy and other preventive measures to avert the late and awry manifestation of the disease as presented in this case. This is a case report of one of numerous cases that may eventually suffer the same fate if urgent preventive measures are not instituted. A 20-year old Nigerian woman with past history of recurrent sore throat and a 10-year history of recurrent easy fatiguability and markedly dilated left atrium and pulmonary hypertension presented when she developed severe pulmonary hypertension. A concerted action at all levels of prevention is needed to reduce the burden of this disease among the young population in developing countries.

Abstract: Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy. However, this technique is costly, is not devoid of complication and success is not guaranteed. Indications of an attempted redo percutaneous mitral valvuloplasty (redo-PMV) are not well established. Hence the idea to study the immediate results of (re-PMV). Purpose of work: The purpose of this study is to evaluate the immediate results of the re-PMV in patients with mitral restenosis and analyze the different clinical and laboratory findings to determine predictors of success of re-PMV to better selection of candidates for a new attempt PMV. Methods: Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon succeeding a successful initial procedure, collected in the cardiology department of Habib Thameur hospital of Tunis between 1996 and 2011, in which we identified the data of clinical and paraclinical examinations. Results: The mean age of patients was 43±11 years [23; 63]. Of the population, 87.5% were female (five men and 35 women). The average time between the two procedures was 8±4 years [1; 15]. The immediate procedural success defined by a mitral valve area greater or equal to 1.5cm2 and a grade less than or equal to 2 mitral regurgitation was obtained in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in three patients (7.5%). A cerebrovascular stroke occurred in one patient (2.5%). No death or cardiac tamponade were noted. Class III or IV of NYHA, a pre-procedural MR, pulmonary hypertension and an overall score of Padial greater than 10 were retained as predictors of failure. More the overall score of Wilkins is high (>8), more it is predictive of failure. The two components of the Wilkins score: valvular mobility and subvalvular apparatus (SVA) and the parameter of the redesign of the SVA score of Padial considered separately are also predictive of failure. Only a left atrial area less than or equal to 25cm2 was linked to high risk of severe MR. Conclusion: Redo percutaneous mitral valvuloplasty is a therapeutic alternative to surgery that is effective and promising interesting immediate results. Analysis of clinical and mainly echographic parameters is useful for predicting the success of the gesture, which will allow a better selection of candidates for re-PMV. [Copyright &y& Elsevier]

Abstract: Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6cm2), a dilation of the trunk of the pulmonary artery (diameter=74mm) and of its branches (diameter of the right pulmonary artery=28mm, diameter of the left pulmonary artery=36mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months. [Copyright &y& Elsevier]

Summary: Introduction: Ortner's syndrome, also known as cardiovocal syndrome, is a rare clinical entity with hoarseness due to left recurrent laryngeal nerve (RLN) palsy owing to a cardiovascular disease. Norbert Ortner ascribed hoarseness of voice RLN palsy in patients with several mitral stenosis, postulating that an enlarged left atrium could be responsible for the recurrent laryngeal nerve palsy. Case report: A 63-year-old man with a history of progressive hoarseness of voice developed since over three months. Flexible laryngoscopy revealed a fixed left vocal cord in the paramedian position. The chest enhanced axial computed tomography confirmed a large left ventricular aneurysm. Conclusions: Hoarseness has significant public health implications. Patients suffer from social deprivation, depression and a poor quality of life. Several underlying conditions are associated with the cardiovocal syndrome, including iatrogenic, congenital, mitral valve disorders, aortic and ventricular aneurysms. Laryngoscopy is indicated for the assessment of hoarseness if symptoms fail to improve or resolve within three months, or at any time when the clinician suspects a serious underlying disorder. [Copyright &y& Elsevier]

Abstract: The objective of this work was to study the indications, techniques and results of closed heart mitral commissurotomy in patients with rheumatic mitral stenosis in Morocco. Methods: All patients who had undergone closed heart mitral commissurotomy for rheumatic mitral stenosis, operated between 1999 and 2008 were collected in this study. Mitral stenosis was diagnosed and evaluated using Doppler echocardiography. Patients with commissural calcification, severe mitral regurgitation, and surgical tricuspid or aortic valvular disease were excluded from this study. Results: Six hundred and twenty-five patients have been collected. 62.2% were young with an age between 18 and 35 years and 491 (78.8%) were female. Seventy-nine percent of patients had stage III or IV NYHA and were in sinus regular rhythm. The closed heart mitral commissurotomy was performed for all patients through a left thoracotomy using either digital or dual dilatation. The mitral area was significantly increased postoperatively to 2.11±0.32 with 100% opening of the anterior commissure, while the posterior commissure was opened only for 93.7% of patients. There were nine perioperative deaths (4.9%) and all patients who died had severe mitral stenosis (<0.8cm2) with an elevated systolic pulmonary artery pressure (>60mmHg). Conclusion: The closed heart mitral commissurotomy provides excellent results in young patients with rheumatic mitral stenosis. [Copyright &y& Elsevier]

Abstract: Pulmonary hypertension is a serious disorder, difficult to treat especially in the severe forms. The treatment consists mainly of calcium channel blockers, anti-coagulation, intravenous epoprostenol, inhaled nitric oxide and recent agents as bosentan and sildenafil. Sildenafil, a phosphodiesterase 5 specific inhibitor, has been largely evaluated in primary pulmonary hypertension, and in some cases of secondary pulmonary hypertension including parenchymal and thromboembolic diseases; it has not yet been evaluated in severe pulmonary hypertension with elevated pre-capillary resistance in operated mitral stenosis. We report the cases of two patients operated from mitral valve replacement for severe mitral stenosis with elevated pre-capillary resistance, where oral sildenafil, introduced empirically immediately after the surgical procedure at the dose of 50 mg/d, permitted a significant decrease in pulmonary pressures and resistances, allowing a rapid withdrawal of nitric oxide and reducing therefore hospitalization time in the intensive care unit. We think that this simple treatment, with or without association to nitric oxide, should be generalized to persistent pulmonary hypertension following cardiac surgery. [Copyright &y& Elsevier]

Abstract: Of 745 patients treated by balloon mitral commissurotomy (BMC) between February 1988 and December 2002, 45 were≥60-years old. Immediate and late outcomes in this group (group 1) were compared with those in the patients aged<60-years (group2). Baseline hemodynamic parameters were comparable in the two groups. Mitral surface area and hemodynamic parameters improved significantly after BMC in group1: mean left atrial pressure fell from 18.76±6.18 to 10.65±4.38 mmHg (P <0.001), mean transmitral gradient from 11.03±4.70 to 4.63±2.05mmHg (p<0.001) and mitral valve area from 0.99±0.22 to 1.88±0.41cm2 (p<0.001). Similar significant improvements were seen in group 2. The hemodynamic result was good in 69% of group1 patients. Tamponade occurred in one patient. Mitral regurgitation grade I or II developed in 8 patients and remained stable in 13 patients. These complication rates were comparable to those seen in group 2. In the group 1, a good result was maintained in 60% of patients after 43±23 months of fllow-up. Although restenosis was observed in 40% of patients, functional amelioration was obtained in most of cases. In the group 2, restenosis was observed in 25% of patients. The data from this study suggest that BMC is effective first therapy in patients aged≥60-years with symptomatic mitral stenosis. [Copyright &y& Elsevier]

Abstract: Introduction. – Lutembacher syndrome refers to the rare combination of congenital atrial septal defect and acquired mitral stenosis. This condition is usually treated surgically by mitral valve operation with concomitant closure of the atrial septal defect. Materials and methods. – Between 1993 and 2003, 4 patients with congenital Lutembacher syndrome had percutaneous mitral commissurotomy without closure of the atrial septal defect at our institution. The 4 patients were very symptomatic with right-sided heart failure signs and NYHA functional class III-IV. Results. – The procedure was carried out successfully for the four patients. Mitral valve area increased from 0,87 to 1,97 cm2 at mean; left atrial pressure decreased from 28,2 to 12,7 mmHg and the mean valve mitral gradient was reduced from 15,5 to 3,9 mmHg. Functional and clinical improvement was observed in all the cases. During a mean follow up of 55±29 months, our 4 patients remain pauci symptomatic under medical treatment. Conclusion. – The percutaneous treatment of the Lutembacher syndrome is currently a possible alternative to the surgery among patients having an anatomy favourable to the procedure. [Copyright &y& Elsevier]

A 78 year-old woman had a NYHA II dyspnoea, which was related to a calcified aortic stenosis. Functional aortic valvular surface was calculated to 0.75 cm2 by echocardiography. In addition, there were important mitral calcifications without mitral stenosis. The left ventricular contractility was normal, but there was a significant left ventricular hypertrophy. At the time of the coronary angiography, the aortic valve was crossed with difficulty. A “pigtail” probe was positioned and during left ventricular angiography, an unexpected aspect of myography was observed with an unusual opacification of the interventricular posterior coronary vein, draining in the coronary sinus. The patient remained strictly asymptomatic during all the procedure. Two echographic controls carried out in the 24 following hours appeared normal, without pericardial effusion nor new parietal anomaly of the left ventricle. Five weeks later, the patient underwent an aortic valve replacement without complication. [Copyright &y& Elsevier]

Pregnancy is one of the most important factors known to destabilize valvular heart disease. In particular, pregnancy is a major cause of aggravation in the clinical course of women with mitral stenosis (MS). Surgical treatement of MS during pregnancy may be hazardous for both mother and fœtus. In this context, percutaneous mitral valvuloplasty using the Inoue balloon may constitute a particularly attractive alternative to surgery. We report the results of percutaneous mitral valvuloplasty achieved in a series of 11 pregnant women. [Copyright &y& Elsevier]

The decrease in the incidence of acute rheumatic fever in western countries has led to a sharp decrease in the incidence of mitral stenosis. This decrease also modifies the clinical presentation and mitral stenosis is now encountered in older patients who have severe impairment of valve anatomy. In developing countries, mitral stenosis remains a frequent disease. The management of patients with mitral stenosis has been modified by the development of percutaneous mitral commissurotomy whose safety and efficacy have been demonstrated in a number of studies with a follow-up of up to ten years. Percutaneous mitral commissurotomy is now the reference treatment for mitral stenosis with pliable valves in young patients and its efficacy has been validated in randomised trials versus surgery. Mitral stenosis in older patients, as it is encountered in western countries, is a more heterogeneous group. Predictive analysis has shown that the predictions of immediate and late results are multifactorial. This has led to consider the indications for percutaneous mitral commissurotomy in patients who do not have ideal anatomic conditions, when their other characteristics are favourable. This is particularly the case in young patients who do not have a very tight mitral stenosis (1–1.5cm2) and who do not have an advanced heart disease. When the conditions are favourable, percutaneous mitral commissurotomy can be considered in patients who have few symptoms, in particular in order to reduce the thromboembolic risk. [Copyright &y& Elsevier]

Abstract: We report the use of continuous spinal anesthesia for hip fracture surgery in a patient with pulmonary arterial hypertension. Preoperative evaluation, anesthetic technique and preoperative monitoring are discussed. [Copyright &y& Elsevier]

Abstract: The tako-tsubo syndrome is the subject of a lot of publications focusing on the different circumstances of discovery (emotion, anesthetic stress…). We report the original case of a patient of 56 years with a tight mitral stenosis, hospitalized for acute lung oedema, sinus rhythm, in which the original data and follow-up studies have identified a tako-tsubo syndrome with favorable evolution. [Copyright &y& Elsevier]

Abstract: Introduction: Ortner''s syndrome was first described as a left laryngeal nerve palsy caused by a dilated left atrium in mitral stenosis. Aortic aneurysm is another well-documented etiology. Case record: We report the case of a 90 year-old woman with temporal artertis with recent onset hoarseness, and simultaneous discovery of aortic arch aneurysm and left vocal cord palsy. Discussion: The occurence of hoarseness and aortic aneurysm in Giant-cell vasculitis is discussed. We suggest to consider Horton''s disease (GCA) as a possible etiology of Orner''s cardiovocal syndrome. [Copyright &y& Elsevier]

Mitraclip corrects mitral regurgitation in a less invasive way than cardiac surgery. These procedures are becoming widespread with the emergence of new complications. We report a rare case of mitral stenosis associated with acute hemolytic anemia after mitraclip treatment in an 82-year-old patient. The cause of this stenosis in our case is linked to the placement of two clips and an increase gradient in post-procedure. The mechanism of hemolysis could be due to the persistence of mitral leaks resulting in strong collisions against the clip., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

After aortic valve diseases, mitral valve diseases represent the most numerous indications of surgical or percutaneous valvular intervention. Surgical management is favoured in severe symptomatic mitral regurgitation. In case of high or prohibitive surgical risk, new techniques are developed to allow percutaneous, less invasive management. In these circumstances, MitraClip® allows the treatment of mitral regurgitation in case of adequate valve morphology. Percutaneous balloon valvuloplasty is currently the first-line treatment of mitral stenosis related to rheumatic disease when anatomical features are favourable. Alongside the Inoue technique, which remains the classical procedure, other approaches are available with encouraging results.

Introduction: The management of pregnancy in patients with mitral valve stenosis disease continues to pose a challenge to the clinician., Objective: The aim of study was to evaluate the association between mitral valve stenosis and maternal and fetal out come., Materiel and Method: Eighty-three pregnant women with mitral valve disease, followed-up from 2009 to 2012, were prospectively evaluated medical history, NYHA class assessment, ECG and echocardiography were performed during pregnancy and after delivery., Results: Women with mitral stenosis had significantly clinical higher incidence of complications deterioration of clinical status was observed (44.57%, P=0.0001) congestive heart failure had observed (27.71%, P=0.0001), hospitalization (33.73%, P=0.0001), need of cardiac medications (53.75%, P=0.009), arrhythmias (16%, P<0.05), New born outcome, mitral stenosis had an effect on fetal outcome. We had increasing preterm, delivery (17.50%, P=0.018), hypotrophy (20.48%, P=0.001), intra-uterine growth retardation (12.04%, P=0.011) new born hospitalizations (13.25%, P=0.03) Increased maternal morbidity and unfavorable fetal outcome was seen mostly in patients with moderate and severe mitral stenosis., Conclusion: Pregnant with critical mitral stenosis form a high-risk groups of life-threatening complications. There is need for close maternal follow-up and fetal surveillance and repair of mitral stenosis should be performed before pregnancy., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: Mitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable., Aim of the Study: The purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment., Patients and Methods: It is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years., Results: Mean patients age was 31.5±4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02±0.5cm 2  averaged to 2±0.35cm 2 . Mitral regurgitation increased in three cases and appeared in two cases. All patients delivered at term. Newborns were all healthy. Two of them had a low birth weight. On the long term follow-up (95.58±64.1 months), five patients had mitral restenosis: two had a surgical valve replacement and three underwent a second percutaneous mitral balloon commissurotomy., Conclusion: The effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Lutembacher's syndrome refers to the rare combination of congenital atrial septal defect and acquired mitral stenosis. It is rarely associated to partial anomalous pulmonary venous connection. This condition is treated surgically by mitral commissurotomy or mitral valve operation with concomitant closure of the atrial septal defect with correction of the abnormal pulmonary venous connection. Percutaneous mitral commissurotomy before surgery can be a therapeutic alternative when mitral valve stenosis is severe and valve anatomy is favourable. The authors bring back the case of a 24 years old man having mitral stenosis in sinus rhythm associated to sinus venosus septal defect and partial anomalous pulmonary venous connection. The diagnosis was made for the age of 17 years old on the occasion of dyspnea. He benefited in February 2003 of rescue percutaneous mitral commissurotomy because of pulmonary oedema. Mitral valve area increased from 0.7 cm(2) to 1.6 cm(2). The patient was clinically approved, so that he refused surgery and was lost sight. Seven years later (August 2010) he was taken back for a second rescue percutaneous mitral commissurotomy because of a very severe mitral stenosis (mitral valve area was 0.8cm(2)), in pulmonary oedema with echocardiographic evaluated pulmonary hypertension at 68mmHg. The trans-septal complicated of a false road from the right atrium, towards the pericardic cavity. The patient was operated as the matter of urgency, and benefited from a mitral valve replacement by mechanical prosthesis, of closure of sinus venosus septal defect by PTFE patch and correction of abnormal pulmonary venous connection. Operating suites were simple, and the postoperative echocardiography concludes to a good prosthesis profile, the absence of residual shunt and a decrease of pulmonary artery blood pressure from 68 to 40mmHg. In conclusion, percutaneous mitral commissurotomy may be a waiting procedure for surgery of this disease or emergency treatment of it's valve anomaly, with regular monitoring while awaiting surgery faster and in better conditions., (Copyright © 2012. Published by Elsevier SAS.)