Percutaneous Transvenous Mitral Commissurotomy in a Patient with Prosthetic Aortic Valve
Ali Faizal DM, C. V. Umesan DM, N. Radhakrishnan MVS, V. Lakshmi M Phil, R. Hemalatha M Phil

Patients with rheumatic valvular heart disease who have undergone valve surgery may present later with progression of disease in other valves. We report a case of successful percutaneous transvenous mitral commissurotomy (PTMC) in a 58-year-old male who underwent aortic valve replacement (AVR) with a No. 23 Björk-Shiley valve for severe rheumatic aortic regurgitation in 1982. At AVR, echocardiography revealed mild mitral stenosis (MS) with a mitral valve area (MVA) of 2.5 cm². Over 18 years, the mitral valve disease progressed to severe MS and the patient presented with class III exertional dyspnea. He underwent successful PTMC by the Inoue balloon technique. Post-procedure echocardiography revealed a MVA of 2.0 cm² and grade II mitral regurgitation. Anticoagulation management, infective endocarditis prophylaxis and procedural modifications are discussed.