Percutaneous transluminal mitral valve commissurotomy Via Veno-Arterial loop method.

Background: Since its inception in 1984 by Inoue and colleagues, percutaneous trans venous mitral commissurotomy (PTMC) is the first line treatment option for severe mitral stenosis with favorable valve morphology. Critical mitral stenosis can however pose a challenge for balloon crossing to the left ventricle. Various techniques have been demonstrated to overcome this difficulty. We use a novel technique to cross mitral valve. Case Presentation: We describe a case where critical stenosis of rheumatic mitral valve in a young lady which was not amenable to conventional PTMC procedure, was successfully performed via veno-arterial rail method. Management & Results: After crossing the interatrial septum, mitral valve was tried to cross with the standard technique using Inoue balloon, but failed because the stenosis was very tight. So we have crossed mitral valve through exchanged length terumo wire which was snared in descending aorta and externalized through right femoral artery and then we were able to pass the balloon through the tight mitral valve and the procedure was completed without any complication. Post procedure the pressure gradient dropped to 4mmHg and the mitral valve area was recorded as 1.8cm 2 with 2D echo planimetry. Conclusion: In difficult to cross MV during PTMC, the veno-arterial rail method can be used easily for a successful procedure.