open access

Vol 14, No 3 (2019)
Case Reports
Published online: 2019-03-27
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Importance of apico-mitral axis during percutaneous transmitral commissurotomy

Santosh Kumar Sinha, Puneet Aggarwal, Mahmadula Razi, Ramesh Thakur
DOI: 10.5603/FC.a2019.0021
·
Folia Cardiologica 2019;14(3):279-282.

open access

Vol 14, No 3 (2019)
Case Reports
Published online: 2019-03-27

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.

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.
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Keywords

severe mitral regurgitation; Accura balloon; apico-mitral axis; chordal rupture

About this article
Title

Importance of apico-mitral axis during percutaneous transmitral commissurotomy

Journal

Folia Cardiologica

Issue

Vol 14, No 3 (2019)

Pages

279-282

Published online

2019-03-27

DOI

10.5603/FC.a2019.0021

Bibliographic record

Folia Cardiologica 2019;14(3):279-282.

Keywords

severe mitral regurgitation
Accura balloon
apico-mitral axis
chordal rupture

Authors

Santosh Kumar Sinha
Puneet Aggarwal
Mahmadula Razi
Ramesh Thakur

References (6)
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  2. Hernandez R, Macaya C, Bañuelos C, et al. Predictors, mechanisms and outcome of severe mitral regurgitation complicating percutaneous mitral valvotomy with the Inoue balloon. Am J Cardiol. 1992; 70(13): 1169–1174.
  3. Dean LS, Mickel M, Bonan R, et al. Complications and mortality of percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry. Circulation. 1992; 85(6): 2014–2024.
  4. Herrmann HC, Lima JA, Feldman T, et al. Mechanisms and outcome of severe mitral regurgitation after Inoue balloon valvuloplasty. North American Inoue Balloon Investigators. J Am Coll Cardiol. 1993; 22(3): 783–789.
  5. Lau KW, Hung JS. Balloon impasse: a marker for severe mitral subvalvular disease and a predictor of mitral regurgitation in Inoue-balloon percutaneous transvenous mitral commissurotomy. Cathet Cardiovasc Diagn. 1995; 35(4): 310–319; discussion 320.
  6. Chern MS, Chang HJ, Lin FC, et al. String-plucking as a mechanism of chordal rupture during balloon mitral valvuloplasty using inoue balloon catheter. Catheter Cardiovasc Interv. 1999; 47(2): 213–217, doi: 10.1002/(SICI)1522-726X(199906)47:2<213::AID-CCD20>3.0.CO;2-D.

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