ATRIAL SEPTAL DEFECT WITH MITRAL VALVULITIS: CLINICAL AND CATHETERIZATION DIAGNOSIS

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Abstract
Previous criteria for the differentiation of an atrial septal defect combined with mitral valvulitis from an isolated atrial septal defect are reviewed and discussed. The presence of a low-pitched rumbling apical diastolic murmur has been known to occur in patients with isolated atrial septal defect. Six cases with this combination were collected from a series of 63 patients who underwent repair of the atrial septal defect. Clinical study of these patients has shown that the previously set criteria are not adequate for its differentiation from the isolated atrial septal defect. Study by right heart catheterization was also not helpful in the differentiation. However, the demonstration of calcification in the mitral valve or the presence of a pressure gradient across the mitral orifice, in the presence of atrial septal defect is more definitely helpful in the diagnosis of Lutembacher''s syndrome. Mitral valvulotomy during repair of the defect was made. In the presence of a predominant mitral insufficiency, repair of the defect resulted in an increase in the pulmonary artery pressure and right ventricular work in one patient studied.