Key result
The over-the-wire technique successfully accomplished percutaneous transluminal mitral commissurotomy in a patient with a deformed mitral valve after the conventional Inoue technique failed.
Case Report (n=1)
The over-the-wire technique is a useful alternative for percutaneous transluminal mitral commissurotomy in patients with deformed mitral valves when conventional techniques fail.
May enable PTMC after Inoue failure in deformed valves; single case leaves open generalizability and need for prospective data.
A 40-year-old woman, known to suffer from rheumatic heart disease, presented with New York Heart Association class III breathlessness of 6 months duration. Transthoracic echocardiogram revealed severe mitral stenosis with deformed double orifice-like mitral valve and severe interatrial septal bulge. Considering the unfavourable anatomy, a high-risk percutaneous transluminal mitral commissurotomy (PTMC) was planned. Initial septal puncture resulted in pericardial effusion with tamponade, which was effectively managed by pericardiocentesis. After haemodynamic stabilisation and a fresh septal puncture, repeated efforts were made to negotiate the balloon across the deformed valve using the conventional Inoue technique. As the attempts were unsuccessful, the authors planned for over-the-wire (OTW) technique, with which the procedure was accomplished successfully. A technically challenging case of PTMC in the presence of adverse factors is presented herein. OTW technique is a useful alternative in the presence of deformed mitral valve.
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Thomas et al. (2011) conducted a case report in Rheumatic heart disease with severe mitral stenosis (n=1). Over-the-wire (OTW) technique for percutaneous transluminal mitral commissurotomy (PTMC) vs. Conventional Inoue technique was evaluated on Successful completion of the procedure. The over-the-wire technique successfully accomplished percutaneous transluminal mitral commissurotomy in a patient with a deformed mitral valve after the conventional Inoue technique failed.
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