A 30-year-old woman with severe breathlessness was found to have a complex congenital heart defect involving holes between the chambers of the heart, severe mitral and tricuspid valve disease, and pulmonary hypertension. A carefully planned complex cardiac surgery successfully corrected the structural abnormalities and treated the damaged heart valves.

Severe Breathlessness at 30 Reveals a Hidden Heart Condition

For a 30-year-old woman, persistent and severe breathlessness had started affecting her daily life. She was experiencing short breathing even with routine activity and orthopnea, a condition in which breathing becomes difficult while lying flat.

She was classified as NYHA Class III, indicating significant limitation of physical activity because of cardiac symptoms.

There was no history of cyanosis, and her oxygen saturation was 96% while breathing room air. However, further cardiac evaluation revealed that the breathlessness was not a routine respiratory problem—it was linked to a complex congenital heart defect that had affected the structure and functioning of her heart.

Investigations Revealed Multiple Heart Abnormalities

An echocardiography examination revealed a combination of significant structural abnormalities.

The patient had a large ostium primum atrial septal defect (ASD) and an inlet ventricular septal defect (VSD).

In simple terms, these defects are abnormal openings between the chambers of the heart. Such defects can allow blood to flow abnormally between the chambers and, over time, place additional stress on the heart and lungs.

The evaluation also revealed serious valve-related complications:

Severe tricuspid regurgitation (TR)

Severe mitral regurgitation (MR)

Cleft mitral valve

Severe pulmonary arterial hypertension (PAH)

Her ejection fraction was 50%.

The combination of septal defects, severe valve dysfunction and pulmonary hypertension made this complex adult congenital heart disease case requiring advanced surgical management.

Understanding the Patient's Complex Heart Condition

The patient's condition was consistent with an atrioventricular septal defect (AVSD), a congenital heart condition involving abnormalities in the structures separating the chambers of the heart and the atrioventricular valves.

In this patient, the defect was not limited to a single abnormal opening. The heart had multiple structural abnormalities involving both the atrial and ventricular septum, along with significant mitral and tricuspid valve disease.

Because the condition had progressed to severe valve dysfunction and pulmonary hypertension, treating only one component would not have been sufficient. The surgical team therefore planned a comprehensive procedure to address the major abnormalities during the same operation.

Cardiac Catheterisation Helped Assess the Severity

A cardiac catheterisation study was also performed to assess the patient's pulmonary vascular condition.

The pulmonary vascular resistance index (PVRI) was measured at 4 Wood units, providing important information about the severity of pulmonary vascular involvement and helping the cardiac team assess the complexity of the case.

With these findings, the patient was evaluated for definitive surgical correction.

Surgery Revealed Extensive Structural Abnormalities

During surgery, the cardiac team found several significant abnormalities.

The pulmonary artery was tense and dilated. There was a common atrium and a small inlet VSD. The mitral valve had a cleft with fibrosed leaflets, while the chordae supporting the valve were shortened.

The tricuspid valve annulus was also dilated, contributing to the severe tricuspid regurgitation.

These findings confirmed the complexity of the patient's congenital heart disease and the need for multiple corrective procedures.

A Comprehensive Surgical Approach

Considering the multiple abnormalities, the cardiac team performed a combination of procedures during the same surgery.

The patient underwent:

1. ASD Closure

The large ostium primum atrial septal defect was closed using a Dacron patch.

2. VSD Closure

The inlet ventricular septal defect was closed directly to eliminate the abnormal communication between the heart's chambers.

3. Tricuspid Valve Repair

The dilated tricuspid valve annulus was addressed through tricuspid valve repair, with the aim of improving valve function and reducing the abnormal backward flow of blood.

4. Mitral Valve Replacement

Because of the severe mitral valve disease, including the cleft mitral valve, fibrosed leaflets and shortened chordae, the patient underwent mitral valve replacement.

A 30 mm bioprosthetic valve was implanted, with preservation of the posterior chordal structures.

The surgery required 126 minutes of cardiopulmonary bypass and an aortic cross-clamp time of 82 minutes, reflecting the complexity of the procedure.

Surgery Performed by an Experienced CTVS Team

The complex procedure was performed at Ujala Cygnus Amritdhara My Hospital, Karnal under the leadership of Dr. Chander Mohan Mittal, Group Senior Director, Department of Cardiothoracic and Vascular Surgery (CTVS), Ujala Cygnus Group.

The case required careful surgical planning because several structural defects and valve abnormalities needed to be addressed together.

Recovery After the Complex Heart Surgery

The patient underwent surgery on 8 June 2026. Following the procedure and postoperative recovery, she was discharged from the hospital on 13 June 2026. At her follow-up on 5 August 2026, the patient was reported to be doing well.

Her recovery represents a positive outcome in a complex adult congenital heart disease case involving multiple structural defects, severe valve disease and pulmonary hypertension.

Why This Case Is Significant

This case highlights an important aspect of congenital heart disease: some congenital heart defects may remain undiagnosed until adulthood and can gradually lead to significant complications.

In this patient, the congenital heart defect was associated with severe mitral and tricuspid valve disease and pulmonary hypertension by the time she presented for treatment.

The case demonstrates the importance of:

Recognising persistent or unexplained breathlessness as a possible sign of underlying heart disease.

Conducting detailed cardiac evaluation when symptoms are significant.

Assessing congenital heart defects comprehensively rather than treating an isolated abnormality.

Addressing associated valve disease when it becomes severe.

Using advanced cardiac surgical expertise for complex congenital heart conditions presenting in adulthood.

A New Beginning After Complex Cardiac Surgery

What initially appeared as severe breathlessness was ultimately found to be the result of a complex congenital heart condition involving multiple structures of the heart.

Through detailed evaluation and a comprehensive surgical approach, the cardiac team corrected the septal defects, repaired the tricuspid valve and replaced the severely diseased mitral valve.

The patient was discharged within five days of surgery and was reported to be doing well at follow-up.

Key Message

Breathlessness should never be ignored, particularly when it is persistent, worsening or associated with difficulty breathing while lying down. Early cardiac evaluation can help identify underlying heart conditions and enable timely treatment.

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