ABSTRACT
Lutembacher’s syndrome, a combination of ASD with significant MS is frequently encountered in developing countries with high prevalence of rheumatic heart disease. The size of ASD & severity of MS determine the hemodynamic effects and the management strategy in a given case. Suspicion of MS in a case of ASD arises in the presence of undue cardiomegaly, a systolic thrill at the upper left sternal edge, an unusually long, loud, and widely transmitted delayed diastolic murmur, and ECG evidence of biatrial enlargement. Transmitral gradients are often underestimated and one has to rely on orifice area for assessing the severity of MS. Transcatheter PTMC is sufficient in a patient with significant MS with favorable valve morphology and a restrictive ASD. PTMC may be life saving in a critically ill patient with pulmonary edema, as bail out therapy, irrespective of the size of ASD. A large ASD with insufficient rims is best treated by surgical closure along with OMV. Although not preferred by us, an ASD with sufficient rims could be closed by a device, after successful PTMC.
