CONGENITAL MITRAL-STENOSIS - CHALLENGE OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY

A 26-year-old woman with congenital mitral stenosis and embolic stroke was referred to our hospital. The echocardiogram showed a hypoplastic posterior mitral valve leaflet with short, unbalanced chordal attachm ents to the posteromedial papillary muscle. The mitral valve area was 0.9 cm(2) by the pressure half-time method. There was no left atrial t hrombus and spontaneous echo contrast. Percutaneous transvenous mitral commissurotomy was performed since the suggestion of surgical managem ent was refused by her family members. A rupture at the chordae tendin ae of the hypoplastic posterior papillary muscle developed during the procedure and needed mitral replacement. We advise that percutaneous t ransvenous mitral commissurotomy be avoided in adult patients with con genital mitral stenosis having an asymmetric and hypoplastic mitral va lve. (C) 1997 Elsevier Science Ireland Ltd.