Lutembacher’s syndrome presenting in the third trimester: a multidisciplinary challenge in a low-resource setting

Lutembacher’s syndrome, the combination of an atrial septal defect and mitral stenosis, is a rare condition in which the diagnosis is often delayed. The physiological stress of pregnancy can precipitate acute decompensation, posing high maternal-fetal risks, especially in low-resource settings where rheumatic heart disease and congenital heart disease are prevalent. We report the first documented case of Lutembacher’s syndrome in a pregnant woman in Afghanistan, highlighting the diagnostic and management challenges in this resource-limited context. A 40-year-old woman at 32 weeks’ gestation presented with decompensated heart failure. Echocardiography confirmed a large secundum atrial septal defect, severe rheumatic mitral stenosis, and severe pulmonary hypertension. After intensive medical management and an assisted vaginal delivery, her postpartum course was complicated by malignant arrhythmias, seizures and episodes of cardiac arrest, requiring advanced life support. Definitive surgical correction was declined due to socio-economic barriers. A multidisciplinary intensive care unit team successfully stabilized and discharged both mother and infant. This first reported case of Lutembacher’s syndrome in a pregnant woman in Afghanistan illustrates the life-threatening complications of Lutembacher’s syndrome in pregnancy and the multifaceted challenges of its management in a low-income setting. It underscores the critical role of a multidisciplinary team in navigating acute clinical crises. Socio-economic factors proved formidable barriers to definitive treatment, highlighting the need for integrated healthcare models that address both clinical needs and the social determinants of health to improve outcomes in resource-constrained environments.