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Annales de cardiologie et d'angéiologie
Volume 55, n° 3
pages 153-156 (juin 2006)
Doi : 10.1016/j.ancard.2005.05.007
Received : 3 December 2004 ;  accepted : 6 May 2005
Commissurotomie mitrale percutanée et syndrome de Lutembacher
Percutaneous mitral commissurotomy and Lutembacher syndrome
 

H. Belghiti , M. Kettani, L. Chami, N. Srairi, N. Fekri, R. Bennani, N. Fellat, N. El Haitem, R. Mesbahi, M. Benomar
Service de cardiologie A, hôpital Ibn-Sina, CHU de Rabat-Salé, Rabat, Maroc 

*Auteur correspondant. Secteur 6 L7, avenue Atthuya-hay-ryad, Rabat, Maroc.
Résumé

Introduction. - Le syndrome de Lutembacher associe une communication interauriculaire congénitale et un rétrécissement mitral. Cette condition relève habituellement d'un traitement chirurgical de remplacement valvulaire mitral et fermeture de la communication interauriculaire.

Matériel et méthodes. - Entre 1993 et 2003, quatre patientes porteuses d'un syndrome de Lutembacher congénital ont été traitées par commissurotomie mitrale percutanée sans fermeture du defect septal interauriculaire dans notre institution. Les quatre patientes étaient en insuffisance cardiaque droite évoluée et présentaient une dyspnée classe III à IV de la NYHA.

Résultats. - La procédure s'est déroulée avec succès pour nos quatre patientes. La surface mitrale est passée en moyenne de 0,87 à 1,97 cm2 ; la pression de l'oreillette gauche a diminué de 28,2 à 12,7 mmHg et le gradient transmitral moyen est passé de 15,5 à 3,9 mmHg. Une nette amélioration fonctionnelle et clinique a été observée dans tous les cas. Durant un suivi moyen de 55±29 mois, nos quatre patientes sont restées peu symptomatiques sous traitement médical.

Conclusion. - Le traitement percutané du syndrome de Lutembacher est actuellement une alternative possible à la chirurgie chez les patients ayant une anatomie favorable à la procédure.

The full text of this article is available in PDF format.
Abstract

Introduction. - Lutembacher syndrome refers to the rare combination of congenital atrial septal defect and acquired mitral stenosis. This condition is usually treated surgically by mitral valve operation with concomitant closure of the atrial septal defect.

Materials and methods. - Between 1993 and 2003, 4 patients with congenital Lutembacher syndrome had percutaneous mitral commissurotomy without closure of the atrial septal defect at our institution. The 4 patients were very symptomatic with right-sided heart failure signs and NYHA functional class III-IV.

Results. - The procedure was carried out successfully for the four patients. Mitral valve area increased from 0,87 to 1,97 cm2 at mean; left atrial pressure decreased from 28,2 to 12,7 mmHg and the mean valve mitral gradient was reduced from 15,5 to 3,9 mmHg. Functional and clinical improvement was observed in all the cases. During a mean follow up of 55±29 months, our 4 patients remain pauci symptomatic under medical treatment.

Conclusion. - The percutaneous treatment of the Lutembacher syndrome is currently a possible alternative to the surgery among patients having an anatomy favourable to the procedure.

The full text of this article is available in PDF format.

Mots clés : Rétrécissement mitral, Communication interauriculaire, Commissurotomie mitrale percutanée

Keywords : Mitral stenosis, Atrial septal defect, Percutaneous mitral commissurotomy




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