title: Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: pathophysiology of hemodynamic collapse and peri-operative management issues.
abstract: Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri-operative management issues in a case of mitral valve replacement for acute severe MR following BMV.
authors.forename: Praveen Reddy
authors.initials: PR
authors.lastname: Bayya
authors.affiliation: Department of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Praveen Kerala
authors.initials: PK
authors.lastname: Varma
authors.forename: Suneel Puthuvassery
authors.initials: SP
authors.lastname: Raman
authors.forename: Praveen Kumar
authors.initials: PK
authors.lastname: Neema
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D063126:Balloon Valvuloplasty / Q000379:methods*; D004630:Emergencies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery; D017202:Myocardial Ischemia / Q000209:etiology; D019990:Perioperative Care / Q000379:methods*; D012214:Rheumatic Heart Disease / Q000150:complications / Q000601:surgery; D012769:Shock / Q000503:physiopathology* / Q000628:therapy