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Masakazu Nakao
Yoong Kong Kenny Sin
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J Thorac Cardiovasc Surg 2008;135:690-691
© 2008 The American Association for Thoracic Surgery

Brief Communication

Acquired right-to-left shunt through an atrial septal perforation with cyanosis after percutaneous transvenous mitral commissurotomy

Masakazu Nakao, MDa,*, Jack Kian Ch'ng, MDa, Yoong Kong Kenny Sin, MBBS, FRCS, FAMSa, Yeow Leng Chua, MBBS, FRCS, FAMSa, Chung Yin Lee, MBBS, FAMSb

a Department of Cardiothoracic Surgery, National Heart Centre, Singapore
b Department of Cardiology, National Heart Centre, Singapore

Received for publication August 30, 2007; accepted for publication October 19, 2007.

* Address for reprints: Masakazu Nakao, National Heart Center, Department of Cardiothoracic Surgery, Mistri Wing, 17 Third Hospital Ave, Singapore 168752. (Email: masakazu.nakao@nhc.com.sg).

The first 20% of the full text of this article appears below.

Atrial septal perforation (ASP) is a known complication after percutaneous transvenous mitral commissurotomy (PTMC), although it usually spontaneously heals. In cases in which ASP persists, the shunting is predominantly left to right, and rarely does the shunting reverse to cause clinical cyanosis.

Clinical Summary

A 49-year-old woman with a history of longstanding rheumatic heart disease presented with breathlessness and cyanosis, as well as bilateral lower limb swelling, for 2 weeks. She had undergone closed mitral valvotomy 26 years ago and subsequent PTMC twice 14 and 4 years ago, respectively. Other significant medical histories are atrial fibrillation and diabetes mellitus. Recent transthoracic echocardiography (TTE) 1 year ago showed moderate mitral stenosis (MS) with a mitral valve area of 1.3 cm2, mild mitral regurgitation (MR), severe tricuspid regurgitation (TR) with a pulmonary artery systolic pressure of 38 mm Hg, and a small atrial septal defect with left-to-right . . . [Full Text of this Article]






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