An unusual complication after mitral valve repair

CITATION: Kabwe, L., Weich, H. & Pecoraro, A. 2019. An unusual complication after mitral valve repair. SA Heart Journal, 16(1):50-51. doi:10.24170/16-1-3416.The original publication is available at https://www.journals.ac.za/index.php/SAHJ/indexENGLISH ABSTRACT: A 22-year-old lady presented to the outpatient department with new onset dyspnoea and effort intolerance. She had a prior history of successful mitral valve repair 5 years previously for symptomatic severe mitral regurgitation, secondary to myxomatous mitral valve prolapse. Clinical examination revealed an undisplaced apex with a parasternal heave (suggestive of right ventricular hypertrophy) and a soft ejection systolic murmur in the pulmonary area. On review of her previous echocardiograms, the pre-surgery apical 4 chamber (Figure 1A) revealed a dilated left ventricle and atrium with normal right heart chambers. Her post-operative echocardiogram (Figure 1B) confirmed successful mitral valve repair with a reduction in left ventricular size and normal right ventricle. A review of her echocardiogram (Figure 1C) at this visit, revealed new right ventricle dilatation with features of diastolic overload. No evidence of tricuspid/pulmonary incompetence was found. Transoesophageal echocardiography (Figure 1D) confirmed a large atrial septal defect (ASD). We concluded that this was an iatrogenic ASD as a complication of mitral valve repair. The ASD was closed percutaneously with an amplatzer device (see online publication for video supplement).https://www.journals.ac.za/index.php/SAHJ/article/view/3416Publisher’s versio