Congenital sub-total IVC obstruction and rheumatic severe mitral stenosis-treated percutaneously in a single stage procedure using the same hardware

Abstract

We report a rare case of a 25-year old female with rheumatic mitral stenosis (MS) with incidentally picked up asymptomatic near complete congenital inferior vena cava (IVC) obstruction. The IVC obstruction made the performance of percutaneous transvenous mitral commissurotomy (PTMC) from the femoral vein approach difficult.The patient subsequently underwent successful PTMC by Inoue technique from the femoral vein access followed by balloon dilatation of membranous obstruction of IVC simultaneously using same hardware. The outcome of the procedure was successful and the patient was discharged in stable condition which has been maintained during the course of follow up.This case is unique in the performance of PTMC and IVC dilatation in the same setting using the same hardware from the femoral vein approach irrespective of the hindrance caused by the IVC obstruction in the performance of PTMC through this approach. There have been case reports of successful IVC stenting for venous web but the combination of these two illnesses is relatively rare occurrence and the performance of both the procedures simultaneously using an Inoue balloon is unique and this report imparts confidence to interventionists for performance of successful PTMC even in cases with critical stenosis of the inferior vena cava and that the two procedures can be completed simultaneously in the same sitting in a cost effective way.