Rapid snare sliding technique: An easy approach to difficult percutaneous transmitral commissurotomy

Abstract

Rheumatic heart disease (RHD) is a major health hazard in most developing countries as well as sporadically in developed economies with high prevalence rates. Mitral stenosis is among the important morbid valvular conditions accounting for 25% of RHD cases. Percutaneous transmitral commissurotomy (PTMC) using Inoue balloon is the standard treatment for severe mitral stenosis with favorable Wilkins score. In certain cases it is difficult to cross mitral valve (MV) either due to dilated left atrium (LA), low septal puncture, or severe mitral valvular and subvalvular stenosis leading to prolonged procedure time or failure of PTMC procedure. We describe a case of RHD with severe mitral stenosis and dilated LA where crossing MV was difficult and successful PTMC was performed using rapid snare sliding technique to cross the MV.<Learning objective: Percutaneous transmitral commissurotomy using Inoue balloon is the standard intervention used to treat severe mitral valvular stenosis worldwide. Sometimes we come across difficulty in crossing mitral valve (MV) due to varied reasons leading to failure of this technique. We present a case of rheumatic heart disease with severe mitral stenosis where we had difficulty to cross MV using various techniques and a rapid snare sliding technique was found to be quick, safe, and a good alternative with good results and few complications. We describe the interventional steps of this technique in this case report.>