open access

Ahead of print
Case Reports
Published online: 2019-07-02
Get Citation

Importance of Veno-arterial (VA) loop in Percutaneous Transvenous Mitral commissurotomy (PTMC)

Santosh Kumar Sinha, Mahmadulla Razi, Kumar Himanshu, Siddarth Samrat
DOI: 10.5603/FC.a2019.0082

open access

Ahead of print
Case Reports
Published online: 2019-07-02

Abstract

Percutaneous trans-mitral commissurotomy (PTMC) using Accura balloon is an effective procedure for management of patients with rheumatic mitral stenosis. Following trans- septal puncture, negotiating the balloon catheter from left atrium (LA) to left ventricle sometimes becomes difficult especially in the background of large left atrium. Over-the-wire technique is one of the methods to bail out in such a situation. Here, we report a case of 10-year old boy suffering from critical rheumatic mitral stenosis in which LA was large (9cm x 8cm) where the mitral valve could not be negotiated with standard technique. Making a reverse loop of partially inflated Accura balloon, 0.014˝ coronary angioplasty wire was introduced into left ventricle (LV) which was further pushed and parked into ascending aorta, thereby establishing a veno-arterial (VA) loop. The balloon was deflated and gradually tracked over the wire across the mitral valve to enter into LV cavity. Once into the cavity, the loop was straightened and mitral valvuloplasty was successfully performed in standard fashion. Thus, this technique is helpful in bailing out in situations of “difficult LV entry” in critically stenosed valve.

Abstract

Percutaneous trans-mitral commissurotomy (PTMC) using Accura balloon is an effective procedure for management of patients with rheumatic mitral stenosis. Following trans- septal puncture, negotiating the balloon catheter from left atrium (LA) to left ventricle sometimes becomes difficult especially in the background of large left atrium. Over-the-wire technique is one of the methods to bail out in such a situation. Here, we report a case of 10-year old boy suffering from critical rheumatic mitral stenosis in which LA was large (9cm x 8cm) where the mitral valve could not be negotiated with standard technique. Making a reverse loop of partially inflated Accura balloon, 0.014˝ coronary angioplasty wire was introduced into left ventricle (LV) which was further pushed and parked into ascending aorta, thereby establishing a veno-arterial (VA) loop. The balloon was deflated and gradually tracked over the wire across the mitral valve to enter into LV cavity. Once into the cavity, the loop was straightened and mitral valvuloplasty was successfully performed in standard fashion. Thus, this technique is helpful in bailing out in situations of “difficult LV entry” in critically stenosed valve.

Get Citation

Keywords

Large left atrium; Veno-arterial Loop; Percutaneous Transvenous Mitral commissurotomy, Critical mitral stenosis.

About this article
Title

Importance of Veno-arterial (VA) loop in Percutaneous Transvenous Mitral commissurotomy (PTMC)

Journal

Folia Cardiologica

Issue

Ahead of print

Published online

2019-07-02

DOI

10.5603/FC.a2019.0082

Keywords

Large left atrium
Veno-arterial Loop
Percutaneous Transvenous Mitral commissurotomy
Critical mitral stenosis.

Authors

Santosh Kumar Sinha
Mahmadulla Razi
Kumar Himanshu
Siddarth Samrat

References (9)
  1. Fawzy ME. Percutaneous mitral balloon valvotomy. Catheter Cardiovasc Interv. 2007; 69(2): 313–321.
  2. Ramamurthy S, Bahl VK, Manchanda SC. Successful inoue balloon valvotomy in a difficult case of mitral stenosis using multiple modifications of technique: alternative method for loop formation of the Inoue balloon catheter. J Invasive Cardiol. 2001; 13(11): 755–757.
  3. Trehan V, Mehta V, Mukhopadhyay S, et al. Difficult percutaneous transvenous mitral commissurotomy: a new technique for left atrium to left ventricular entry. Indian Heart J. 2004; 56(2): 158–162.
  4. Safi AM, Kwan T, Clark LT. Successful percutaneous balloon mitral valvuloplasty using left ventricular pressure as a guide to cross the mitral valve--a case report. Angiology. 2000; 51(1): 83–86.
  5. Deora S, Vyas C, Shah S. Percutaneous transvenous mitral commissurotomy: a modified over-the-wire technique for difficult left ventricle entry. J Invasive Cardiol. 2013; 25(9): 471–473.
  6. Bugliani-Pastalka L, Bugliani G, Suter T, et al. [Long-term results after successful mitral valvuloplasty: comparison of Inoue and double balloon technique]. Schweiz Med Wochenschr. 2000; 130(35): 1216–1224.
  7. Joseph G, Chandy S, George P, et al. Evaluation of a simplified transseptal mitral valvuloplasty technique using over-the-wire single balloons and complementary femoral and jugular venous approaches in 1,407 consecutive patients. J Invasive Cardiol. 2005; 17(3): 132–138.
  8. Meier B. Modified Inoue technique for difficult mitral balloon commissurotomy. Catheterization and Cardiovascular Diagnosis. 1992; 26(4): 316–318.
  9. Mehan VK, Meier B. Impossibility to cross a stenotic mitral valve with the Inoue balloon: success with a modified technique. Indian Heart J. 1994; 46(1): 51–52.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl