Silent patent ductus arteriosus incidentally found before balloon mitral valvotomy for severe rheumatic mitral stenosis.

Rheumatic heart disease (RHD) and congenital heart disease (CHD) rarely co-exist in the same patient. However, such associations are not unknown in areas where RHD is endemic. We report a rare combination of severe rheumatic mitral stenosis, severe pulmonary artery hypertension (PAH), and an incidental clinically silent patent ductus arteriosus (PDA). The patient was initially subjected to a balloon mitral valvotomy to assess if the resultant fall in PA pressure would alter the flow dynamics of the PDA. Since the ductal flow remained small and clinically inaudible, no further intervention was advised. The case highlights the importance of detailed echocardiographic examination in patients with RHD to detect co-existent CHD and logical decision making in their management. <Learning objective: A detailed echocardiographic examination is needed in all cases even when a diagnosis is apparent. Despite obvious rheumatic mitral stenosis, meticulous echocardiography revealed a small PDA, which was clinically silent. Since severe PAH can alter findings of PDA, we first performed balloon mitral valvotomy to see if resultant fall in PA pressure would alter the flow dynamics of PDA. Despite fall in PA pressures, the PDA flow remained trivial and it was clinically inaudible. Hence, no further intervention was advised.>.