|Year : 1979 | Volume
| Issue : 4 | Page : 243-244
False negative mitral valve echo in a case of lutembacher's syndrome
Lilam S Shah, JJ Dalal, AS Vengsarkar
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, India
Lilam S Shah
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012
Source of Support: None, Conflict of Interest: None
A case of false negative mitral valve echo gram in a case of Lutembacher's Syndrome is reported. In our understanding this is the first case report in the literature.
|How to cite this article:|
Shah LS, Dalal J J, Vengsarkar A S. False negative mitral valve echo in a case of lutembacher's syndrome. J Postgrad Med 1979;25:243-4
| :: Introduction|| |
Though echocardiography is useful in diagnosing mitral valve lesions and right ventricular volume over load seperately there are conditions where both the lesions are co-existent; in our case we obtained a false negative mitral valve echogram in a combined lesion of secondum atrial septal defect and rheumatic tight mitral stenosis.
| :: Case report|| |
H.S., a 26 year old female, came to our hospital complaining of breathlessness and palpitation. There was no history of joint pains. She had effort intolerance class II of NYHA. Clinical examination revealed hyperdynamic rigs ventricle, ejection systolic murmur in pulmonary area, 2nd sound widely split and fixed with moderate accentuation of pulmonic component. Tricuspid diastolic rumble was present and the 1st heart sound was moderately accentuated in the tricuspid area. There was no evidence of apical mid-diastolic murmur, presystolic murmur or opening snap. A clinics diagnosis of left to right shunt at atrial level was made. There was no evidence of rheumatic mitral stenosis.ECG showed right axis deviation (AQRS + 110°), and right bundle branch block. There was no left atrial hypertrophy. X-ray chest revealed cardiomegaly, right ventricular enlargement, dilated pulmonary artery segment and increased pulmonary arterial vasculature. There was no left atrial enlargement or pulmonary venous congestion.
Her echocardiogram (See [Figure 1] on page 242B) revealed normal mitral valve. Posterior mitral leaflet was normal. EF (110 mm/sec) and DE (30 mm/sec.) slopes were normal. Both leaflets were thin; left atrial size was normal. The septum showed paradoxical systolic motion. Right ventricular dimension was 5.2 cms. Her cardiogram was consistent with the diagnosis of atrial septal defect. Right heart catheter did not reveal any significant increase in pulmonary artery wedge pressure; this suggested a diagnosis of atrial septal defect and the patient was subjected to surgery.
At surgery, the patient was found to have ostium secundum atrial septal defect which was patched with a dacron graft. Following atrial septal defect closure, the patient developed pulmonary oedema and on careful search she was found to have tight mitral stenosis of rheumatic etiology. This is an interesting false negative mitral valve echo in rheumatic mitral stenosis with associated ostium secundum atrial septal defect.
| :: Discussion|| |
We have no possible explanation to account for the false negative mitral valve echogram. In the literature there is no such reported case though Gibson  has an account of one such case at the Brompton Hospital, London
| :: References|| |
|1.||Gibson, D. G.: Personal communication. |