A 65-year-old obese lady visited BLK emergency due to difficulty in breathing. She was diagnosed with Pulmonary Edema and was virtually drowned in her own secretions, thus unable to breathe. A prompt Emergency department team along with the Cardiology team quickly intubated her and resuscitated her back to life. Historically, she was a known case of Rheumatic Mitral Stenosis. Echo evaluation revealed that she had Critical Mitral Stenosis with mitral valve area of 0.6 cm2. Her valve seemed suitable for Balloon Mitral Valvotomy (BMV) - a non-surgical method to treat such high-risk patients.
Her management after stabilisation hinged around the extent of underlying coronary artery disease, whether she needed Combined Open Heart surgery for Mitral Valve Replacement and Coronary Artery Bypass Graft surgery or an alternative non-surgical modalities to treat her morbidities. While she was still on ventilator, her Coronary Angiography revealed double vessel, critical disease, amenable to Coronary Angioplasty and Stenting. Another dilemma was the sequence of Balloon Mitral Valvotomy and Coronary Angioplasty. High levels of anticoagulation required during Angioplasty made Balloon Mitral Valvotomy as a default first strategy as trans septal puncture during Balloon Mitral Valvotomy is done in non-coagulated state to avoid the catastrophe of pericardial tamponade. Hence, Balloon Mitral Valvotomy was successfully done first, followed by Double Vessel Coronary Angioplasty under full dose anticoagulation at the same sitting.
She was extubated the same day and discharged within the next two days of hospitalisation. This was a rare feat involving usage of combined coronary and structural – heart interventions in a very sick patient to avoid Open Heart surgery and the consequent risks involved.
Dr. Subhash Chandra
Chairman & HOD - Cardiology
BLK Heart Centre
BLK Super Speciality Hospital
“A Balloon Valvotomy is the
preferred treatment for Mitral
Valve Stenosis. It is a
procedure that widens the
mitral valve so that blood flows
more easily through the heart.”