title: Retrograde non trans-septal balloon mitral valvotomy in mitral stenosis with interrupted inferior vena cava, left superior vena cava, and hugely dilated coronary sinus.
abstract: A 22-year-old woman with severe mitral stenosis was referred to us for further evaluation and management. She was found to have severe mitral stenosis, severe tricuspid regurgitation with dilated right atrium and right ventricle with persistent left superior vena cava and hugely dilated coronary sinus. Valve was suitable for balloon mitral valvotomy. Cardiac catheterization showed interrupted inferior vena cava with azygos continuation to right atrium and large left superior vena cava draining to coronary sinus which was very much dilated. Right trans-jugular approach was tried for balloon mitral valvotomy, but was unsuccessful due to a very large right atrium and coronary sinus. Retrograde non trans-septal approach was used and balloon valvotomy was done successfully using a 24 mm × 40 mm TYSHAK balloon without any major complication. Reduction in the transmitral pressure gradient on cardiac catheterization data and transthoracic echocardiography confirmed successful procedure. Balloon mitral valvotomy can be done successfully in patients with the above unusual cardiac anatomy with no major procedural complications.
authors.affiliation: Department of Cardiology, PGIMER, Dr. RML Hospital, New Delhi, India.
authors.forename: Ranjit Kumar
authors.initials: RK
authors.lastname: Nath
authors.affiliation: Department of Cardiology, PGIMER, Dr. RML Hospital, New Delhi, India.
authors.forename: Dheeraj Kumar
authors.initials: DK
authors.lastname: Soni
mesh_terms: D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization; D054326:Coronary Sinus / Q000473:pathology* / Q000503:physiopathology; D004108:Dilatation, Pathologic; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000175:diagnosis; D054079:Vascular Malformations / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000503:physiopathology; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000503:physiopathology; D055815:Young Adult
keywords: TYSHAK balloon; azygus vein; balloon mitral valvotomy; coronary sinus; interrupted inferior vena cava; left superior vena cava; mitral stenosis