April 2011

This patient developed sudden dyspnoea while visiting Australia. Preoperative echocardiography reported severe AS and mild to moderate MR most likely secondary to rheumatic changes. Intraoperatively the MR was noted to be more severe with vena contracta width of 5mm and a MR jet reaching to the back wall of the LA. There was no flow reversal in the left upper pulmonary vein.

Patient underwent AVR and MV repair with an annulopasty ring. Concern was raised regarding the repair with high pressure gradients across the MV and spontaneous echo contrast in the LA.

The patient was put back on bypass and the repair of the MV explored. A replacement was ruled out as the patient would be returning  to an isolated region without followup or anticoagulation monitoring.

Follow up 2 month later showed that the patient was functionally well with good exercise tolerance. TTE showed a mild MS with no MR.


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