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Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don¡¯t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-223

Symptomatic Severe Mitral Stenosis in a Pregnant Lady

By Su Min Lim

Presenter

Su Min Lim

Authors

Su Min Lim1

Affiliation

Pulau Pinang Hospital, Malaysia1,
View Study Report
TCTAP C-223
Structural - Other Structural Interventions

Symptomatic Severe Mitral Stenosis in a Pregnant Lady

Su Min Lim1

Pulau Pinang Hospital, Malaysia1,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

25 yr old lady G2 P1 @ 23 week pregnancyreferred from district hospital C/O SOB , treated by district hospital as AEBASpo2 dropped in ward and proceeded to intubation for airway protection and admitted to ICUFurther history also revealed history of similar SOB in 1stpregnancy and treated with inhalers CXR from district hospital show cardiomegaly and given frusemide and improvedExtubated 2 days later 

Relevant Test Results Prior to Catheterization


TOE done showed Severe MR with MVA planimetry  0.66 and MPG 30MDT meeting Discussed and pt agree for PTMC 

Relevant Catheterization Findings


Interventional Management

Procedural Step

Abdominal shield and peri operative TTELFA / 6Fr under USG guidance RFV/7Fr 6Fr pigtail at Ao, RA gram and follow Transseptal puncture under fluoroscopy guidance Wollie wire to LA PTMC inouoe balloon intrpduced but unable to direct to MVdespite manipulation – likely due to low septal puncture Decided to create AV loop- long terumo wire RA-LA-LV-AOSnared at aortic arch & externalisation  Successfully crossed MV Balloon inflation X2 (26 mm) Well tolerated with transient hypotension Rpt ECHO MVA 1.53cm2 MPG 8mmHg, no pericardial effusion

Case Summary

Low septal puncture in this case resulting difficulties to direct the balloon to MV- should aim high posterior puncture - to consider TOE guidance puncture if available as it can better guide the puncture site

Snare and create AV looping to facilitate the movement into MV is an potential solution in this case than redo transseptal puncture