Why the study?
Rheumatic mitral stenosis complicating pregnancy is common in cardio-obstetrics clinics in India and requires a heart team approach for successful fetal and maternal outcomes.
A transarterial retrograde approach is a safe and effective alternative for balloon mitral valvotomy in pregnant patients with severe mitral stenosis and interrupted inferior vena cava where the standard transvenous approach is impossible.
This case supports feasibility of retrograde transarterial BMV in select pregnant patients with interrupted IVC; leaves open safety and efficacy questions for broader adoption.
BACKGROUND: Rheumatic mitral stenosis complicating pregnancy is a common clinical scenario encountered in cardio-obstetrics clinics in India. The condition needs a heart team approach for successful fetal and maternal outcomes. CASE SUMMARY: A 26-year-old woman, at 28 weeks of gestation, with an interrupted inferior vena cava presented with severe mitral stenosis. Transarterial retrograde balloon mitral valvotomy was performed using a 25 × 40 mm Tyshak balloon catheter because of the inability to do it transvenously. DISCUSSION: Anatomic variability in the form of an interrupted inferior vena cava and inability to perform transseptal puncture through the right internal jugular vein prompted the heart team to successfully perform transarterial retrograde ballon mitral valvotomy in this pregnant patient. TAKE-HOME MESSAGE: An alternate plan of management should always be prepared when a complex interventional procedure is being planned in a pregnant patient with a variant anatomy.
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Ramesh et al. (2025) studied this question.
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