Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Case Report

Volume 9, Number 6, December 2018, pages 385-391

Combined Percutaneous Procedure in Patient with Lutembacher Syndrome: A Case Report and Real-World Experience Review

Figure 1. The percutaneous mitral valvuloplasty procedure. (a) The wire crosses from right atrium to the left atrium through the ASD; (b) the Inoue balloon is introduced to the left ventricle; (c) the Inoue balloon is partly inflated and withdrawn toward mitral valve; (d) the balloon is fully expanded.

Figure 2. The percutaneous ASD closure procedure. (a) The sizing balloon is advanced through the superstiff wire and inflated at the atrial septum until the waist is clearly seen; (b) the device is selected and fully opened at the atrial septal defect; (c) the device after release at the anterior posterior view; (d) the device is in good position at the left anterior oblique and cranial view.

Figure 3. The echocardiography exam before and 12 months after procedure. (a) Mitral valve at parasternal short axis view, before mitral valvuloplasty; (b) mitral valve at parasternal short axis view, after mitral valvuloplasty; (c) the color Doppler echocardiography at parasternal short axis view shows an ASD with left to right shunt; (d) the Cocoon Septal Occluder is in good position without residual shunt.

**Table 1.** Transcatheter Treatment for Lutembacher Syndrome in Literature
Year	Author	Age (years)	Sex	ASD size (mm)	MVA (pre/post) (cm²)	Balloon, dilated size	ASD device, size
^a15- and 20-mm valvotomy balloon catheter (Mansfield Scientific Inc.). ^bThe 24-mm Amplatzer ASD occluder was deployed first without success. ^cThe first 30-mm Amplazer device deployment was failed. ^dASD closure was performed 48 h after mitral valvuloplasty. ^eThe first 30-mm Amplazer device was mal-position and retrieved percutaneously. ^fThe post procedural MVA was not available.
1992	Ruiz et al [15]	43	Female	20	0.4/1.0	Double balloon^a	Lock clamshell, 40 mm
1999	Joseph et al [16]	23	Female	16	1.1/2.2	Joseph, 25 mm	Amplatzer, 16 mm
2000	Chau et al [28]	26	Female	18	0.6/1.8	Inoue, 24 mm	Amplatzer, 20 mm
2003	Aroney et al [29]	61	Female	13	1.2/2.2	Inoue, 26 mm	Amplatzer, 14 mm
2003	Ahmed et al [19]	42	Female	11	1.0/1.5	Inoue, 26 mm	Amplatzer, 17 mm
2004	Ledesma et al [30]	39	Female	22	1.4/2.1	Inoue, 26 mm	Amplatzer, 28 mm^b
2005	Xiang-qian et al [21]	61	Female	18	1.0/2.2	Jinchang, 26 mm	Lifetech, 24 mm
2007	Ho et al [26]	28	Female	18	1.5/2.4	Inoue, 24 mm	Amplatzer, 19 mm
2008	Shabbir et al [27]	17	Female	15	0.9/1.9	Inoue, 24 mm	Amplatzer, 20 mm
2010	Ozdemir et al [25]	49	Female	15	1.5/2.1	Inoue, 28 mm	Amplatzer, 16 mm
2011	Behjatiardakani et al [35]	50	Female	28	1.3/2.5	Inoue, 26 mm	Amplatzer, 32 mm
		52	Female	26	1.2/2.5	Inoue, 26 mm	Amplatzer, 32 mm
2012	Bhambhani et al [22]	32	Male	19	1.0/1.9	Inoue, 24 mm	Amplatzer, 30 mm
2013	Malviya et al [17]			22	0.9/1.8	Accura, 26 mm	CeraFlex, 26 mm
2014	Babu et al [24]	42	Female	12	0.7/2.0	Accura, 24 mm	Cocoon, 14 mm
2014	Arora et al [34]	38	Female	22	0.9/1.8	Inoue, 24 mm	Amplatzer, 32 mm^c
2014	Goel et al [32]	17	Female	19	0.8/2.1	Inoue, 26 mm	Cocoon, 20 mm^d
2014	Thomas et al [36]	38	Female	26	0.7/1.9	Inoue, 24 mm	Amplatzer, 28 mm
2014	Vadivelu et al [18]	18	Male	27	0.7/1.8	Inoue, 26mm	Heartr™, 36 mm^e
2015	Salam et al [3]	25	Female	14	1.3/3.1	Inoue, 24 mm	Amplatzer, 18 mm
2016	Kamana et al [13]	36	Female	24	1.2^f	Inoue, 26 mm	Cocoon, 30 mm
2016	Datta et al [20]	55	Female	14	0.7/1.3	Inoue, 25 mm	Heartr™,18 mm
2017	Mathur et al [33]	18	Male	30	1.1/1.8	Accura, 28 mm	Amplatzer, 38 mm
2018	Phan et al	59	Female	24	1.0/1.9	Inoue, 24 mm	Cocoon, 26 mm

Table 1. Transcatheter Treatment for Lutembacher Syndrome in Literature

Year

Author

Age (years)

Sex

ASD size (mm)

MVA (pre/post) (cm²)

Balloon, dilated size

ASD device, size

^a15- and 20-mm valvotomy balloon catheter (Mansfield Scientific Inc.). ^bThe 24-mm Amplatzer ASD occluder was deployed first without success. ^cThe first 30-mm Amplazer device deployment was failed. ^dASD closure was performed 48 h after mitral valvuloplasty. ^eThe first 30-mm Amplazer device was mal-position and retrieved percutaneously. ^fThe post procedural MVA was not available.

1992

Ruiz et al [15]

Female

0.4/1.0

Double balloon^a

Lock clamshell, 40 mm

1999

Joseph et al [16]

Female

1.1/2.2

Joseph, 25 mm

Amplatzer, 16 mm

2000

Chau et al [28]

Female

0.6/1.8

Inoue, 24 mm

Amplatzer, 20 mm

2003

Aroney et al [29]

Female

1.2/2.2

Inoue, 26 mm

Amplatzer, 14 mm

2003

Ahmed et al [19]

Female

1.0/1.5

Inoue, 26 mm

Amplatzer, 17 mm

2004

Ledesma et al [30]

Female

1.4/2.1

Inoue, 26 mm

Amplatzer, 28 mm^b

2005

Xiang-qian et al [21]

Female

1.0/2.2

Jinchang, 26 mm

Lifetech, 24 mm

2007

Ho et al [26]

Female

1.5/2.4

Inoue, 24 mm

Amplatzer, 19 mm

2008

Shabbir et al [27]

Female

0.9/1.9

Inoue, 24 mm

Amplatzer, 20 mm

2010

Ozdemir et al [25]

Female

1.5/2.1

Inoue, 28 mm

Amplatzer, 16 mm

2011

Behjatiardakani et al [35]

Female

1.3/2.5

Inoue, 26 mm

Amplatzer, 32 mm

Female

1.2/2.5

Inoue, 26 mm

Amplatzer, 32 mm

2012

Bhambhani et al [22]

Male

1.0/1.9

Inoue, 24 mm

Amplatzer, 30 mm

2013

Malviya et al [17]

0.9/1.8

Accura, 26 mm

CeraFlex, 26 mm

2014

Babu et al [24]

Female

0.7/2.0

Accura, 24 mm

Cocoon, 14 mm

2014

Arora et al [34]

Female

0.9/1.8

Inoue, 24 mm

Amplatzer, 32 mm^c

2014

Goel et al [32]

Female

0.8/2.1

Inoue, 26 mm

Cocoon, 20 mm^d

2014

Thomas et al [36]

Female

0.7/1.9

Inoue, 24 mm

Amplatzer, 28 mm

2014

Vadivelu et al [18]

Male

0.7/1.8

Inoue, 26mm

Heartr™, 36 mm^e

2015

Salam et al [3]

Female

1.3/3.1

Inoue, 24 mm

Amplatzer, 18 mm

2016

Kamana et al [13]

Female

1.2^f

Inoue, 26 mm

Cocoon, 30 mm

2016

Datta et al [20]

Female

0.7/1.3

Inoue, 25 mm

Heartr™,18 mm

2017

Mathur et al [33]

Male

1.1/1.8

Accura, 28 mm

Amplatzer, 38 mm

2018

Phan et al

Female

1.0/1.9

Inoue, 24 mm

Cocoon, 26 mm

**Table 2.** The Echocardiographic and Hemodynamic Changes After the Procedure
Parameter	Before procedure (n = 24)	After procedure (n = 24)	P
Qp/Qs: pulmonary/systemic blood flow ratio. *Immediately after mitral valvuloplasty.
Mitral valve area (cm²)	1.00 ± 0.29	2.00 ± 0.43	< 0.001
Mean pulmonary arterial pressure (mm Hg)	29.2 ± 10.4	19.3 ± 6.1	< 0.001
Mean left atrial pressure (mm Hg)	15.6 ± 5.4	7.33 ± 2.65	< 0.001
Mean transmitral pressure (mm Hg)	11.9 ± 5.9	3.27 ± 2.2	< 0.001
Qp/Qs*	3.62 ± 1.09	1.83 ± 0.56	< 0.001

Table 2. The Echocardiographic and Hemodynamic Changes After the Procedure

Parameter

Before procedure (n = 24)

After procedure (n = 24)

Qp/Qs: pulmonary/systemic blood flow ratio. *Immediately after mitral valvuloplasty.

Mitral valve area (cm²)

1.00 ± 0.29

2.00 ± 0.43

< 0.001

Mean pulmonary arterial pressure (mm Hg)

29.2 ± 10.4

19.3 ± 6.1

< 0.001

Mean left atrial pressure (mm Hg)

15.6 ± 5.4

7.33 ± 2.65

< 0.001

Mean transmitral pressure (mm Hg)

11.9 ± 5.9

3.27 ± 2.2

< 0.001

Qp/Qs*

3.62 ± 1.09

1.83 ± 0.56

< 0.001