title: Transjugular percutaneous transvenous mitral commissurotomy (PTMC) using conventional PTMC equipment in rheumatic mitral stenosis with interruption of inferior vena cava.
abstract: BACKGROUND
  Isolated interruption of the inferior vena cava (IVC) is a rare anomaly. We report a series of 4 cases of isolated interruption of the IVC that coexisted with rheumatic mitral stenosis. Interrupted IVC precludes the use of the femoral approach to percutaneous transseptal mitral commissurotomy (PTMC). We describe the jugular approach to PTMC in such cases using conventional PTMC equipment.
  
  
  RESULTS
  The mean pre-PTMC mitral valve area was 0.85 cm². Septal puncture was done through the right internal jugular vein with a pediatric Brokenborough needle (Medtronic) using the levophase of pulmonary artery angiogram and the pigtail as guide. The mitral valve was crossed successfully in all cases and appropriately sized Accura balloons (Vascular Concepts) were used for incremental dilatations. Successful balloon dilatation was achieved in all 4 cases (mean post-PTMC mitral valve area of 1.85 cm²) with no complications.
  
  
  CONCLUSIONS
  The jugular approach appears to be a safe and effective alternative in cases of rheumatic mitral stenosis with IVC anomalies, thereby preventing an otherwise necessary surgery.
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
authors.forename: Ravindranath K
authors.initials: RK
authors.lastname: Shankarappa
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Math
authors.forename: Srinivas B
authors.initials: SB
authors.lastname: Chikkaswamy
authors.forename: Maneesh K
authors.initials: MK
authors.lastname: Rai
authors.forename: Satish
authors.initials: S
authors.lastname: Karur
authors.forename: Ramesh
authors.initials: R
authors.lastname: Dwarakprasad
authors.forename: Manjunath C
authors.initials: MC
authors.lastname: Nanjappa
mesh_terms: D000328:Adult; D000792:Angiography; D063126:Balloon Valvuloplasty / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006346:Heart Septum; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008946:Mitral Valve Stenosis / Q000628:therapy*; D011677:Punctures; D012214:Rheumatic Heart Disease / Q000628:therapy*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000002:abnormalities*