Wire-based percutaneous balloon mitral valvuloplasty after failed conventional valve crossing: a case report

Percutaneous balloon mitral valvuloplasty (PBMV), an important treatment for rheumatic mitral stenosis (MS), can be technically challenging in cases with difficult anatomy. This article describes a new wire-based PBMV technique involving the advancement of an Inoue balloon over a pre-shaped rigid 0.035-inch wire. The procedure begins with a targeted transseptal puncture, followed by introduction of a steerable sheath into the left atrium and subsequent passage across the diseased mitral valve (MV), replacement with a preformed 0.035-inch stiff wire in the left ventricle, advancement and positioning of an appropriately sized Inoue balloon over the MV on the wire, and inflation of the balloon. This technique uses additional equipment such as a steerable sheath and a preformed 0.035-inch stiff wire, in addition to the standard Inoue balloon kit. This may make the technique more costly. Due to the rheumatic MS occurs less commonly, socioeconomically developed societies, the number of operators experienced in PBMV procedures is quite rare. PBMV can be performed safely and predictably on the wire using the approach described.