Vol 14, No 3 (2019)
Case report
Published online: 2019-03-27
Importance of apico-mitral axis during percutaneous transmitral commissurotomy
Folia Cardiologica 2019;14(3):279-282.
Abstract
The development of acute severe mitral regurgitation (MR) requiring surgery is one of the most dreaded complications of percutaneous transmitral commissurotomy. We present the case of a 29 year-old female with severe rheumatic mitral stenosis whose mitral valve dilatation was performed using an Accura balloon. Once the balloon catheter had crossed the mitral valve to reach the left ventricle, it was facing away from the apico-mitral axis. It was inflated in distal portion, and mitral valve dilatation was done in the usual fashion. She developed acute severe MR. As it was misaligned with the apico-mitral axis, it caused a chordae rupture of the postero-medial papillary muscle which was identified during surgery. We conclude that a misaligned Accura balloon catheter during balloon inflation can pluck the chordae tendinae and can cause acute severe mitral regurgitation, and therefore can unearth the underlying subvalvular pathology.
Keywords: severe mitral regurgitationAccura balloonapico-mitral axischordal rupture
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