A 22 years old female presented with dyspnea on exertion and hoarseness of voice for last six months

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A 22 years old female presented with dyspnea on exertion and hoarseness of voice for last six months. Examination revealed loud first heart sound with diatolic murmur and tapping apex beat. ECG revealed p mitrale and sinus rhythm. Echocardiogram revealed MV orifice area of 1 cm2. Please answer the following:


a) What is Ortner’s Syndrome?

b) What is new scoring system for deciding surgical vs percutaneous treatment?

c) How will you calculate valve area on cardiac catheterization?

d) What are the contraindications to percutaneous transmural balloon valvuloplasty?

Answers:


a.      Hoarseness occurs when dilated left atrium impinges on the recurrent laryngeal nerve
b.      Hung Scoring system
c.       By Gorlin Equation
d.      The following are contraindications for PMBV (ie, class III recommendations): 
  •  Percutaneous mitral balloon valvotomy is not indicated for patients with mild MS (level of evidence: C) 
  •  Percutaneous mitral balloon valvotomy should not be performed in patients with moderate to severe MR or left atrial thrombus (level of evidence: C)

Reference:

  1. Chapter 16, page 283 – Mitral Valve Disease - Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC
  2. Baumgartner H, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009 Jan;22(1): 14.[Pubmed]

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