Iranian Heart Journal

Iranian Heart Journal

Transseptal Triumph: Overcoming the Challenges of Balloon Mitral Valvotomy in a Rigid Interatrial Septum: A Case Report

Document Type : Case Report

Authors
Barun Kumar ΒΆ
Kishan Mavani
Kanika Kukreja
Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India.
Abstract
Background: Balloon mitral valvotomy (BMV) is a well-established, commonly performed interventional procedure for the treatment of rheumatic mitral stenosis, offering symptomatic relief and improved hemodynamics. Despite its routine nature, certain anatomical variations and pathological changes can present significant procedural challenges, occasionally escalating to life-threatening complications if not managed appropriately. One such challenge is the presence of a thickened and fibrotic interatrial septum (IAS), which can complicate the critical step of transseptal puncture required to access the left atrium for balloon crossing.

Case Presentation: We report the case of a 67-year-old man with severe rheumatic mitral stenosis who underwent BMV complicated by dense fibrotic thickening of the IAS. This abnormality posed considerable difficulty during the transseptal puncture and subsequent passage of the valvotomy balloon catheter. To overcome this obstacle, a novel approach utilizing a percutaneous transluminal angioplasty (PTA) balloon to dilate the fibrotic septum was employed, facilitating successful transseptal access and completion of the valvotomy.

Conclusion: This case highlights the importance of assessing patient-specific anatomy when performing BMV. When the atrial septum is fibrotic, adjunctive techniques such as PTA balloon dilatation can facilitate transseptal access. Identifying these challenges early and adjusting the approach accordingly may improve procedural efficiency and clinical outcomes. (Iranian Heart Journal 2026; 27(3): 71-75)
Keywords
BMV
IAS
TEE
PTA balloon
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Iranian Heart Journal
Volume 27, Issue 3
Summer 2026
Pages 71-75