DESCRIPTION

Rheumatic heart disease is the most common cause of mitral stenosis, and percutaneous balloon mitral valvotomy (BMV) has stood the test of time as the standard therapy for the same. We describe a very unusual complication of cardiac catheterisation that occurred during an otherwise uneventful procedure. A 65-year-old woman was diagnosed with severe mitral stenosis due to rheumatic heart disease. She was in atrial fi brillation and was admitted for BMV. She had a history of stroke from which she had recovered. Patient was on oral anticoagulation that was stopped and unfractionated heparin was given instead, prior to the procedure. Patient’s mitral valve was suitable for BMV, with no demonstrable left atrial/left atrial append-age clot on transoesophageal echocardiography (TEE). The patient underwent a fl uoroscopy and transthoracic echocardiography (TTE) guided BMV. Intraprocedural heparin according to bodyweight (70 μ/kg) was admin-istered following septal puncture. Intraprocedural ACT was not monitored as the procedure time was only 30 min. Balloon dilatation was done using Inoue balloon. Postdilation TTE showed good commissural splitting with an increase in MV area and a mild postprocedural MR. There was no clot/pericardial effusion with nor-mal interatrial septum (IAS). However, TTE done 10 min after procedure revealed a mass attached to the IAS ( fi gures 1 and 2). Balloon integrity checked immediately was normal. A possibility of IAS haematoma 1 /thrombus was considered. TEE subsequently done confi rmed that it was an IAS mobile thrombus projecting into both the atria ( fi gure 3). Patient’s anticoagulation was intensifi ed. Repeat ECHO done after 1 month showed complete res-olution of the clot. Images in... An unusual complication of cardiac catheterisation durin