A Case of Mitral Stenosis

DR. MUAZZAM HASAN DR.
MOHAMMAD RASHID
Name Age Sex Address
: Salman : 18yrs : Male : S/O Aftab R/O Jamal pur, Aligarh
Diagnosis : Mitral stenosis with pulmonary hypertension CADS C/I D.O.A D.O.S : 33583/13 : Prof M.H.Beg/Dr Azim Hasan : 26/11/13 : 4/12/13
Progressive breathlessness
: 10 years
Recurrent cough with sputum : 1 year

Palpitations (on and off) : 1 month
According to the patient he was apparently well 10 years back when he developed difficulty in breathing during brisk walking and running.
The difficulty progressed gradually over time, and presently he was even unable to perform his daily activities due to breathlessness.
Patient also had history of recurrent cough which was associated with sputum for last one year.
Patient also had episodes of undue awareness of heart beat on and off for the last month.
For these complaints, patient consulted a local private practitioner. He was diagnosed as a case of mitral stenosis and was to J.N.M.C for further management.
There is no H/O
vertigo Unconciousness
Hemoptysis
Pink frothy sputum Orthopnoea Paroxysmal nocturnal dyspnoea Hoarseness Abdominal distension or pain
Past History
ATT 10 yrs back.
Treated for pneumonia 8yrs back
No H/O DM,HTN. Patient or attendants do not recall history of fever with sore throat and joint pain in childhood.
Personal History
sleep - decreased
bowel
- normal
bladder - normal appetite - decreased
Family History nothing significant Anaesthesia history Nil
Tab digoxin 0.25 mg od Tab lacilactone 20mg bd Started by roc cardiology from 26/11/2013
The patient is a young male of average built, sitting comfortably and well oriented in time , place and person. General condition fair Pallor IcterusClubbingCyanosis Lymphadenopathy Pedal edema ABSENT +
Vitals:
Pulse rate :86/min(regular, low volumic) B.P. :104/64mm of Hg
R.R
Temp
:20/ min
: afebrile
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
B/L equal air entry, Vesicular breath sounds,
No adventitious sounds.
Inspection
precordium normal in shape, no dilated veins Palpation
apex beat at 5th ICS mid axilliary line

no heave or thrill Auscultation loud S1 mid-diastolic murmur present( best at apex) early systolic murmur present
CNS

Patient well oriented with time, place and person. Higher functions - Normal Cranial nerves Reflexes GCS - Intact - Intact -15/15
No sensory or motor deficit.
Vitals:
Pulse rate :92/min B.P. R.R :90/54mm of Hg :20/ min
Temp
: afebrile
Dyspnea NYHA -III

Chest pain(on exercise) Palpitations
present
present present
Pedal edema
Vertigo Convulsions Cough Addiction Allergy
16
absent
Mouth opening MP Neck movement Teeth
: Adequate : MP I : Adequate : No false or loose tooth
Weight
: 35kg
Chest B/L equal air entry,

Vesicular breath sounds, No adventitious sounds CVS S1 loud diastolic murmur present early systolic murmur present
Hemoglobin
TLC DLC
: 11.1 gm%
: 10600 cells/mm3 : P70 L25 Mxd5
Blood Sugar (R) : 115 mg%

Blood Urea : 46mg%
Serum Creatinine: 1.6 mg% S. NA S.K : 134 : 4.1
Xray chest -
ECG
P-mitrale in several leads
Severe mitral stenosis with sever PHTN MVA= 0.6cm2 RA/RV dilated TR present (severe) EF = 66%
ADVICE :
Pt may be taken up for surgery. NPO X 8hrs prior to surgery Kindly arrange for GA Kindly arrange for Blood as per surgical losses. Kindly get a a morning S. K+ on the day of surgery and bring to OT. Kindly continue tab digoxin as adviced.
kindly stop tab lacilactone one day prior to surgery.

Tab Alprazolam 0.25 mg HS night before surgery.
Date
: 04/12/13
Operation : Mitral Valvotomy PREOPERATIVE VITALS :

PR BP
: 108/min : 96/64 mm of Hg
Chest
CNS
: B/L wheeze, ronchi present

: WNL
TECHNIQUE :
under GA IV access in Rt hand All monitors attached.
PREMEDICATION :
Inj. ondensetron
Inj. Fentanyl
4 mg iv
50 ug iv
Pre oxygenation with 100% oxygen 5mins. Induced with inj. Thiopentone 200+50 mg iv. Relaxed with inj. succinylcholine 75 mg iv. OTI done with CETT (pvc) of size 6.5 mm Maintained with Oxygen ,Nitrous oxide , IPPV, Inj. Vecuronium.
TIME 09:30 am
PR 98
BP 104
SPO2 96
IVF NS1
IVD
REMARKS
09:45 am
10:00 am 10:15 am 10:30 am 10:45 am
94
86 88 84 82
96
90 96 98 102
88
90 96 97 97 BLOOD Inj fentanyl 30ug
ETCO2=45 CVP= 35
ETCO2=46 Valve dilated CVP= 30
11:00 am
11:15 am
79
80
96
98
99
99 CVP=28 ETCO2=42
POSTOPERATIVE EXAMINATION : Vitals :

PR 84 /minute BP 102/65 mm Hg Recovery: satisfactory Reflex: WNL Respiration: regular, adequate tidal volume GCS : 15/15 PUPILS NSNR
Patient was extubated
Post operative advice:

NPO TFO Moist O2 inhalation Nurse in propped up position Good analgesia Patient shifted to ICU for post op monitoring and then shifted to ward second day under satisfactory condition.
THANK YOU

A Case of Mitral Stenosis

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DR. MUAZZAM HASAN DR.

Name Age Sex Address

: Salman : 18yrs : Male : S/O Aftab R/O Jamal pur, Aligarh

Recurrent cough with sputum : 1 year

ATT 10 yrs back.

Treated for pneumonia 8yrs back

bladder - normal appetite - decreased

Family History nothing significant Anaesthesia history Nil

B/L equal air entry, Vesicular breath sounds,

apex beat at 5th ICS mid axilliary line

No sensory or motor deficit.

Dyspnea NYHA -III

Mouth opening MP Neck movement Teeth

: Adequate : MP I : Adequate : No false or loose tooth

Chest B/L equal air entry,

Blood Sugar (R) : 115 mg%

Serum Creatinine: 1.6 mg% S. NA S.K : 134 : 4.1

kindly stop tab lacilactone one day prior to surgery.

Operation : Mitral Valvotomy PREOPERATIVE VITALS :

: B/L wheeze, ronchi present

ETCO2=46 Valve dilated CVP= 30

POSTOPERATIVE EXAMINATION : Vitals :

Patient was extubated

Post operative advice:

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