title: Percutaneous closure of a secundum atrial septal defect and double balloon valvotomies of a severe mitral and aortic valve stenosis in a patient with Lutembacher's syndrome and severe pulmonary hypertension.
abstract: This is a 43-yr-old female presenting with recurrent atrial septal defect, closed surgically, 10 years prior, severe aortic and mitral stenosis, and severe tricuspid regurgitation. She was considered inoperable because of the severe pulmonary hypertension and the complexity of the disease. A percutaneous umbrella closure of the atrial septal defect in conjunction with mitral and aortic balloon valvotomies could be safely and successfully performed. After significant clinical and hemodynamic improvement, surgery was judged feasible, but was refused by the patient who suddenly expired 8 weeks later. The usefulness of percutaneous therapy as a rescue procedure and the management of patients with Eisenmenger's physiology are discussed.
authors.affiliation: Heart Institute, Loma Linda University Cardiology Service, Hospital of the Good Samaritan, Los Angeles, CA 90017.
authors.forename: C E
authors.initials: CE
authors.lastname: Ruiz
authors.forename: H
authors.initials: H
authors.lastname: Gamra
authors.forename: P
authors.initials: P
authors.lastname: Mahrer
authors.forename: J W
authors.initials: JW
authors.lastname: Allen
authors.forename: M P
authors.initials: MP
authors.lastname: O'Laughlin
authors.forename: F Y
authors.initials: FY
authors.lastname: Lau
mesh_terms: D000328:Adult; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002404:Catheterization / Q000295:instrumentation*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000628:therapy*; D008185:Lutembacher Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D010166:Palliative Care; D011859:Radiography; D012008:Recurrence; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000628:therapy