Iranian Heart Journal

Iranian Heart Journal

Percutaneous Transvenous Mitral Commissurotomy in a Postoperative Patient With the Pericardial Patch Repair of an Atrial Septal Defect

Document Type : Case Report

Authors
Rajesh Vijayvergiya
Jyothi Vijay
Ganesh Kasinadhuni
Sanjeev Kaushal
Navjyot Kaur
Rajat Sharma
Department of Cardiology , Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
Coexistence of an atrial septal defect (ASD) and acquired rheumatic mitral valve disease is uncommon. Transseptal puncture during percutaneous transvenous mitral commissurotomy (PTMC) can be technically difficult and challenging in patients with the pericardial or synthetic patch at the interatrial septum following ASD repair. We describe a middle-aged woman who had pericardial patch repair of ASD during childhood and now presented with severe, symptomatic rheumatic mitral stenosis. She had successful PTMC through a transseptal approach, following the puncture of the pericardial patch. The technical details about the transseptal approach following the surgical patch repair of the ASD are discussed in the article. (Iranian Heart Journal 2022; 23(2): 116-119)
Keywords
Atrial septal defect
Iatrogenic atrial septal defect
Mitral stenosis
Percutaneous transvenous mitral commissurotomy
Pericardial patch
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Iranian Heart Journal
Volume 23, Issue 2
Spring 2022
Pages 116-119

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Extended Abstract
Supplementary Video 1: Percutaneous transluminal mitral commissurotomy (PTMC) through the pericardial patch at the atrial septum is demonstrated herein. The Brockenbrough needle is tracked down below the aortic bulge in the anteroposterior view. The septal puncture is performed in the lateral view, followed by the Inoue wire placement within the left atrium. The next step sees the successful balloon dilatation of the mitral valve.