CASE Percutaneous Mitral Valvuloplasty in an Adult Patient With Calcific Rheumatic Mitral Stenosis

A 75 year old man with long-standing rheumatic mitral stenosis who refused surgical intervention was treated with percutaneous balloon valvuloplasty. Prevalvulo plasty evaluation revealed a heavily calcified mitral valve, a mean transvalvular gradient of 18 mm Hg, a Fick cardiac index of 1.7 liters/min per m 2, a mitral valve area of 0.6 cm 2 and 1 + mitral regurgitation. After trans septal catheterization and balloon dilation of the inter atrial septum with an 8 mm angioplasty balloon, a 25 mm valvuloplasty balloon was advanced over a guide wire across the interatrial septum and positioned across the mitral anulus. Subsequent balloon inflation at 3 atm pressure resulted in a reduction of the mean mitral valve gradient to 12 mm Hg, an increase in cardiac index to 2.5 liters/min per m 2, an increase in mitral valve area in 1.4 cm 2 and an increase in mitral regurgitation from balloon angioplasty