Percutaneous Transvenous Mitral Commisurotomy in a Patient with Severe Mitral Stenosis Associated with Circulating Blood Lupus Anticoagulant

Abstract

A forty-six year old female with severe mitral valve stenosis complicated by thrombocytopenia and a positive test for lupus anticoagulant was reported. Ten years ago, she was diagnosed to have thrombocytopenia when she received a mastectomy. She had a history of total of 6 spontaneous abortions, but no history of thromboembolic episodes. She received a steroid hormone therapy for thrombocytopenia for 5 years, but thrombocyte count did't show an increase. A year ago, she suffered from a congestive heart failure. At a local hospital, digitalis and a diuretics were given to her, but her condition remained unimproved.She was referred to our hospital. On phisical examination, a diastolic rumble and an opening snap were audible at the apex of the heart. A hepatosplenomegaly was noted. Laboratory tests revealed a thrombocytopenia with the count of 58, 000/mm3, and the prolongation of APTT as well as bleeding time. Radioisotopic examination employing111 In revealed a platelet life span of 4.6 days. A serum β-TG and a serum PF-4 levels were markedly increased.The serum anticardiolipin antibody titre level was significantly high. The serum mixing test between the sera from this patient and the sera from healthy persons showed a marked prolongation of APTT.A cardiac catheterization revealed severe mitral valve stenosis with a transvalvular pressure gradient of 25.2mmHg, and a pulmonary arterial pressure of 68/32mmHg. Since the risk for an open-heart surgery was too high in a patient with coagulopathy and thrombocytopenia, the treatment of choice seemed to be a percutaneous transvenous mitral commissurotomy (PTMC). In our case, the transmitral pressure gradient dropped from 25.2 to 12.9mmHg after PTMC. She was able to go back to her daily life.