Percutaneous Trans Mitral commissurotomy (PTMC) in the background of giant left atrium using Reverse Loop Entry technique

Abstract

Percutaneous trans-mitral commissurotomy (PTMC) using Accura balloon is an effective procedure for management of patients with rheumatic mitral stenosis. It is not uncommon to come across giant left atrium (LA) especially in the developing world as patient often present late in the course of the disease. This is a technically challenging situation as usual landmark changes which make the procedure difficult beginning from septal puncture to negotiation of balloon into left ventricle across the mitral valve. Here we report a case of 16-year old girl suffering from rheumatic mitral stenosis in which left atrium was giant (13cm x 11cm) where the mitral valve could not be negotiated with standard technique. Valvotomy was successfully executed by reverse loop entry technique.