case_images: PMC10853446_01
case_images: (A) Transeptal puncture with guiding TEE. (B) MP-6fr catheter via Mullins longsheath introducer into the left ventricle, inserting an exchange-length 0.035" Terumo wire into the left ventricle and across the aortic valve into the descending aorta. (C) Veno-arterial loop:0.035" exchange length Terumo wire directed from the LV to the descending aorta with the help of a 6Fr MP catheter inside Mullin's longsheath and it being snared with a snare kit inside a JR diagnostic catheter. (D) The Inoue balloon was dilated over snared Terumo wire to dilate the commissural part of the mitral valve.
case_images: fcvm-11-1334444-g001.jpg
case_images: PMC10853446_01_fcvm-11-1334444-g001.jpg
case_images: F1
case_images: Standard steps were followed using a Brockenbrough needle through 8Fr Mullins introducer sheath for an interatrial septum (IAS) puncture (Figure 1A), and the left atrium was entered. However, the wire was not supporting the Inoue balloon's entry into the left ventricle (Figure 1B). We could then advance the Inoue balloon system into the left ventricle (LV) across the veno-arterial rail, which provided more support and directed it toward the apex of the left ventricle (Figure 1C). PBMV was then completed with serial dilatations of Inoue balloon no. 26 mm (Figure 1D).
case_images: Echocardiography pre- and post- percutaneous balloon mitral valvotomy (PBMV). (A) Initial data showed mean valve area (MVA) plannimetry was 0.3 cm and mean valve gradient (MVG) 18.7 mmHg. (B) Post PBMV showed mean valve area (MVA) plannimetry was 1.0 cm and mean valve gradient (MVG) 6.68 mmHg.
case_images: fcvm-11-1334444-g002.jpg
case_images: PMC10853446_01_fcvm-11-1334444-g002.jpg
case_images: F2
case_images: The procedure was successfully completed, as the MV area increased to 1 cm2, and the mean mitral valve gradient was reduced from 11 to 5 mmHg with no mitral regurgitation or hemodynamic disturbances observed (Figure 2).