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CARDIAC SURGERY _____________________________________________________

Recurrent Mitral Stenosis and an Intra-Atrial Mitral Valve Mass 40 Years After Tubbs Mitral Commissurotomy Wobbe Bouma, M.D.,* Inez J. Wijdh-den Hamer, M.D.,* Albert J.H. Suurmeijer, M.D., Ph.D.,y Joost M. van der Maaten, M.D.,z and Massimo A. Mariani, M.D, Ph.D.* *Department of Cardiothoracic Surgery, University Medical Center Groningen, Groningen, The Netherlands; yDepartment of Pathology, University Medical Center Groningen, Groningen, The Netherlands; and zDepartment of Cardiothoracic Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands doi: 10.1111/jocs.12313 (J Card Surg 2015;30:272–273)

Figure 1. (A) Transesophageal echocardiography showed a thickened mitral valve with an echogenic mass (‘‘band’’) extending from the posterior leaflet to the interatrial septum. (B and C) Intraoperative photographs of the fibrous, thickened, and stenotic mitral valve with a fibrous band extending from segment P1/P2 to the interatrial septum. (D) Microscopic histopathologic photograph of the band and its attachment to the thickened posterior leaflet.

Conflict of interest: The authors acknowledge no conflict of interest in the submission. Address for correspondence: Wobbe Bouma, M.D., Department of Cardiothoracic Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. Fax: þ31-50-3611347; e-mail: [email protected]

J CARD SURG 2015;30:272–273

A 71-year-old female developed progressive dyspnea 40 years following a Tubbs closed transventricular mitral commissurotomy for mitral stenosis. Transesophageal echocardiography showed a thickened mitral valve with an echogenic mass extending from the posterior leaflet to the interatrial septum (Fig. 1A), severe mitral stenosis (mean pressure gradient 14.3 mmHg), and a normal left and right ventricular function. Following a median sternotomy, the mitral valve was exposed with a left atriotomy, which revealed a fibrous, thickened, and stenotic mitral valve, especially at the A2

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level (Fig. 1B and C). Additionally, a fibrous band extending from segment P1/P2 to the interatrial septum was seen. The mitral valve was excised and replaced with a bioprosthesis. The postoperative recovery was uneventful. Microscopic histopathologic examination of the band and its attachment to the thickened leaflet (Fig. 1D) showed hyaline fibrosis in the band and focal nodular calcifications and myxoid changes in the leaflet. The etiology of the fibrous band was most likely related to the healing process following the transventricular mitral commissurotomy.

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Recurrent mitral stenosis and an intra-atrial mitral valve mass 40 years after tubbs mitral commissurotomy.

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