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Ann Card Anaesth. 2019 Jul-Sep;22(3):318-320. doi: 10.4103/aca.ACA_54_18.

Troubleshooting for epileptiform activity during percutaneous transvenous mitral commisurotomy.

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Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.


Percutaneous transvenous mitral commisurotomy (PTMC) is a frequently used minimally invasive procedure for patients with symptomatic mitral stenosis. However, it is not without complications. Few complications which are distinctive to the procedure are thromboembolism, left-to-right shunts, mitral regurgitation, cardiac tamponade and complete heart block. We present the case of a 32-year-old female patient scheduled for a PTMC, who had multiple complications during the procedure. She developed cardiac tamponade for which pericardiocentesis and autotransfusion was done. Subsequently she exhibited epileptiform activity for which there was a diagnostic dilemma due to the presence of multiple confounding factors. However, she had a complete recovery without any residual sequelae at the time of discharge.


Cardioemboli; epileptiform activity; fentanyl; local anesthetic systemic toxicity; percutaneous transvenous mitral commisurotomy


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