Percutaneous Mitral Balloon Commissurotomy in an African Patient With Left‐Sided Inferior Vena Cava: A Rare Case Report

Figures

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  Figure 1. The 12‐lead ECG demonstrated atrial fibrillation with a heart rate of 112 beats per min, characterized by an irregularly irregular ventricular rhythm, absence of discrete P waves, and variable R–R intervals. Occasional premature ventricular complexes were also noted.

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  Figure 2. (A) Parasternal long‐axis view showing markedly thickened mitral valve leaflets with restricted diastolic opening (white arrow), consistent with severe rheumatic mitral stenosis. (B) Apical four‐chamber view with color Doppler demonstrating turbulent flow across the mitral valve (red arrow), indicating significant transmitral gradient.

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  Figure 3. (A) Sheath venogram from the right common femoral vein demonstrating a left‐sided inferior vena cava (IVC), indicated with a red arrow, terminating at the left renal vein and crossing anterior to the aorta to join the normal prehepatic segment of the IVC. (B) Schematic diagram demonstrating a left‐sided IVC (blue) ascending on the left, draining into the left renal vein, and crossing anterior to the abdominal aorta (red) to connect with the normal right‐sided prehepatic IVC.

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  Figure 4. Fluoroscopic image demonstrating advancement of the Mullins dilator over the coiled guidewire through the left‐sided inferior vena cava during PMBC.

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  Figure 5. Fluoroscopic image of the Accura balloon, fully inflated across the mitral valve during percutaneous mitral balloon commissurotomy (PMBC), indicated by the red arrow.