open access

Vol 14, No 2 (2019)
Case Reports
Published online: 2019-05-22
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Percutaneous trans-mitral commissurotomy in juvenile mitral stenosis with aneurysmal left atrium — a technically challenging situation

Santosh Kumar Sinha, Vinay Krishna, Hitender Kumar, Mahmodulla Razi, Lokendra Rekwaal, Ramesh Thakur, Puneet Aggarwal
DOI: 10.5603/FC.2019.0034
·
Folia Cardiologica 2019;14(2):169-173.

open access

Vol 14, No 2 (2019)
Case Reports
Published online: 2019-05-22

Abstract

Percutaneous trans-mitral commissurotomy (PTMC) using an Accura balloon is an effective procedure for the mana- gement of patients with rheumatic mitral stenosis. It is not infrequent to encounter an aneurysmal left atrium (LA), especially in the developing world where patients often present very late. This is a technically challenging procedure as the septum often bulges into the right atrial side, making the puncture often difficult. Furthermore, it bulges anteriorly and inferiorly so it becomes even more challenging. Because of the vertical lie of the septum, the needle often dissects the septum rather than puncturing it.  Here, we describe the case of a 17 year-old boy with severe mitral stenosis with a giant, aneurysmal left atrium (LA — 13.5 × 16 cm) where an inter-atrial septal puncture was achieved by probing the fossa ovalis to enter the left atrium instead of a conventional transseptal puncture. PTMC was successfully done, increasing the mitral valve area from 0.8 cm2 to 1.9 cm2. 

Abstract

Percutaneous trans-mitral commissurotomy (PTMC) using an Accura balloon is an effective procedure for the mana- gement of patients with rheumatic mitral stenosis. It is not infrequent to encounter an aneurysmal left atrium (LA), especially in the developing world where patients often present very late. This is a technically challenging procedure as the septum often bulges into the right atrial side, making the puncture often difficult. Furthermore, it bulges anteriorly and inferiorly so it becomes even more challenging. Because of the vertical lie of the septum, the needle often dissects the septum rather than puncturing it.  Here, we describe the case of a 17 year-old boy with severe mitral stenosis with a giant, aneurysmal left atrium (LA — 13.5 × 16 cm) where an inter-atrial septal puncture was achieved by probing the fossa ovalis to enter the left atrium instead of a conventional transseptal puncture. PTMC was successfully done, increasing the mitral valve area from 0.8 cm2 to 1.9 cm2. 
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Keywords

aneurysmal left atrium; probing fossa ovalis; Brockenbrough needle; percutaneous trans-mitral commissurotomy; trans-septal puncture

About this article
Title

Percutaneous trans-mitral commissurotomy in juvenile mitral stenosis with aneurysmal left atrium — a technically challenging situation

Journal

Folia Cardiologica

Issue

Vol 14, No 2 (2019)

Pages

169-173

Published online

2019-05-22

DOI

10.5603/FC.2019.0034

Bibliographic record

Folia Cardiologica 2019;14(2):169-173.

Keywords

aneurysmal left atrium
probing fossa ovalis
Brockenbrough needle
percutaneous trans-mitral commissurotomy
trans-septal puncture

Authors

Santosh Kumar Sinha
Vinay Krishna
Hitender Kumar
Mahmodulla Razi
Lokendra Rekwaal
Ramesh Thakur
Puneet Aggarwal

References (9)
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