Abstract
INTRODUCTION AND SIGNIFICANCE: Lutembacher syndrome (LS), combining atrial septal defect (ASD) and mitral stenosis (MS), is rare, particularly in rural areas. This case presents a 55-year-old Nepalese woman with LS symptoms; however, financial constraints hindered surgical treatment, highlighting LS challenges and the need for early intervention in resource-limited settings. CASE PRESENTATION: A 55-year-old woman from rural Nepal presented with 30-day leg swelling and shortness of breath. Apart from autosomal dominant polycystic kidney disease (ADPKD) and smoking, she had no significant comorbidities. Clinical examination revealed severe mitral stenosis and an ASD, but financial limitations prevented surgery. CLINICAL DISCUSSION: LS is rarer in regions with low rheumatic heart disease (RHD) prevalence like Nepal. This case, despite rarity, delayed presentation, and financial barriers, emphasizes early intervention's importance. While rheumatic fever wasn't confirmed, clinical and echocardiographic findings suggest rheumatic mitral stenosis. The patient's surgery reluctance due to finances highlights resource limitations' impact. CONCLUSION: This Nepalese LS case highlights its complexity and management challenges, especially in resource-limited settings. It stresses early intervention's importance and the impact of financial constraints on patient care. The study urges improved healthcare access and alternative funding in high RHD-prevalence regions.