Haris Bin Bilal Rafi, Waqar Ahmed, MBY Bilal.
Horn of the Rhino at the tip of the LV.
Pak J Cardiol Jan ;15(1):50-2.

Our patient reported to the out patient department in July 1989, she was diagnosed with severe Mitral stenosis, and the valve area was < 1.0 mm2.. She underwent Closed Mitral Valvotomy, in August 1989, and was discharged with near normal gradient across the mitral valve. In 1992 she again reported with shortness of breath, palpitations and chest pain. She was reevaluated and was diagnosed with restenosis of the same valve. The patient did not report to the hospital for 9 years and kept on taking treatment from a general practitioner. She reported to us in the outpatient department on 25th April 2003, she presented with shortness of breath, signs of pulmonary edema and chest pain. She was evaluated and was having severe mitral stenosis. On echo cardiogram she had a dilated LA, severely stenosed mitral valve and the valve area was 0.6 mm2 On transoesophageal echocardiogram there was no clot in LA or LA appendage, but the valve was mildly calcified. On Doppler mean pressure gradient was found to be 18 mm of Hg. She underwent Percutaneous Transluminal Mitral Commissurotomy on 5 h May 2003 the valve was successfully dilated with 24 Inoue balloon, the balloon was inflated up to 22mm There was no residual gradient across the valve. A horn like pseudo aneurysm was seen at the apex of LV on left ventriculogram, this looked like a typical horn of a rhinoceros at the tip of the LV. We took it to be the result of Tubb`s dilator which was passed at the specific site at the tip of the LV, at the time of previous surgery.

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