A 50-year-old woman with symptomatic moderate mitral valve stenosis of rheumatic origin and mild mitral regurgitation underwent percutaneous mitral valvuloplasty (PMV). The Wilkins score of the mitral valve was 8, with minimal calcification of the valve and subvalvular apparatus, commissural fusion, moderate thickening of the leaflets, and moderate reduction of its mobility. Mitral valve area determined by pressure half-time method, by proximal isovelocity surface area method and by direct planimetry using real time threedimensional transesophageal echocardiograFigure 1. RT3D-TEE. The catheter for transseptal approach crosses the interatrial septum with the distal end in the left atrium (upper side of the image). LA = left atrium; RA = right atrium; long arrow = interatrial septum; short arrow = distal end of the catheter.
We report a 51-year-old patient with platypnea-orthodeoxia syndrome after percutaneous closure of a secundum atrial septal defect, an unusual complication of this modality of treatment. Echocardiography, the main diagnostic technique in the present case, showed that one of the percutaneous device's rims was fixed to the anterior wall of the inferior cava vein. Furthermore it showed that the blood flowed from the inferior cava vein, through the defect in the atrial septum, into the left atria.
A 70-year-old man was referred to our hospital to receive a transthoracic echocardiogram because of atrial fibrillation. Physical examination, chest X-ray, and electrocardiogram were normal. When performing the echocardiography, an image compatible with a huge aneurysm of the interatrial septum was found (A and B, Online Videos 1 and 2). Color-flow Doppler demonstrated the existence of a little left-to-right shunt in the anterior junction of the aneurysm with the interatrial septum with Qp/Qs ratio of 1.2. Agitated saline contrast injection opacified the right chambers, and no passage of agitated saline across the shunt was demonstrated (C). Transesophageal echocardiography showed the same findings (D to F, Online Videos 3, 4, and 5). Surgery for aneurysm resection was decided on. A large whitish membrane, with a small rounded orifice in its anterior side, was resected, and the atrial septal defect was closed with a pericardial patch (G to I). The patient was discharged 8 days after an uneventful post-operative period.
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