Intractable Hemoptysis in Mitral Stenosis Treated by Emergency Mitral Commissurotomy

Abstract

Massive life-threatening hemoptysis in mitral stenosis is very rare. Two cases of emergency mitral valvulo-tomy and 1 case of mitral valve replacement with a Starr-Edwards prosthesis performed as emergency procedures, because of severe hemoptysis were reported previously. This case report represents the 3rd reported case of emergency valvulotomy performed for intractable pulmonary hemorrhage in a patient with mitral stenosis. Massive hemoptysis occurs early in the natural course of mitral stenosis before the development of severe pulmonary vascular changes and reduced cardiac output. The source of bleeding was engorged submucosal bronchial veins which develop secondary to elevation of mean left atrial pressure. Following valvulotomy in this case, complete cessation of pulmonary hemorrhage was obtained. Emergency valvulotomy can be a life saving procedure in patients with mitral stenosis and intractable pulmonary hemorrhage.