Transjugular percutaneous transvenous mitral commissurotomy (PTMC) using conventional PTMC equipment in rheumatic mitral stenosis with interruption of inferior vena cava

Ravindranath K. Shankarappa, Ravi S. Math, Srinivas B. Chikkaswamy, Maneesh K. Rai, Satish Karur, Ramesh Dwarakprasad, Manjunath C. Nanjappa

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Isolated interruption of the inferior vena cava (IVC) is a rare anomaly. We report a series of 4 cases of isolated interruption of the IVC that coexisted with rheumatic mitral stenosis. Interrupted IVC precludes the use of the femoral approach to percutaneous transseptal mitral commissurotomy (PTMC). We describe the jugular approach to PTMC in such cases using conventional PTMC equipment. METHODS AND RESULTS: The mean pre-PTMC mitral valve area was 0.85 cm2. Septal puncture was done through the right internal jugular vein with a pediatric Brokenborough needle (Medtronic) using the levophase of pulmonary artery angiogram and the pigtail as guide. The mitral valve was crossed successfully in all cases and appropriately sized Accura balloons (Vascular Concepts) were used for incremental dilatations. Successful balloon dilatation was achieved in all 4 cases (mean post-PTMC mitral valve area of 1.85 cm2) with no complications. CONCLUSION: The jugular approach appears to be a safe and effective alternative in cases of rheumatic mitral stenosis with IVC anomalies, thereby preventing an otherwise necessary surgery.

Original languageEnglish
Pages (from-to)675-678
Number of pages4
JournalJournal of Invasive Cardiology
Volume24
Issue number12
Publication statusPublished - 01-12-2012

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Mitral Valve Stenosis
Inferior Vena Cava
Mitral Valve
Equipment and Supplies
Dilatation
Neck
Jugular Veins
Thigh
Punctures
Pulmonary Artery
Needles
Blood Vessels
Angiography
Pediatrics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Shankarappa, Ravindranath K. ; Math, Ravi S. ; Chikkaswamy, Srinivas B. ; Rai, Maneesh K. ; Karur, Satish ; Dwarakprasad, Ramesh ; Nanjappa, Manjunath C. / Transjugular percutaneous transvenous mitral commissurotomy (PTMC) using conventional PTMC equipment in rheumatic mitral stenosis with interruption of inferior vena cava. In: Journal of Invasive Cardiology. 2012 ; Vol. 24, No. 12. pp. 675-678.
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Transjugular percutaneous transvenous mitral commissurotomy (PTMC) using conventional PTMC equipment in rheumatic mitral stenosis with interruption of inferior vena cava. / Shankarappa, Ravindranath K.; Math, Ravi S.; Chikkaswamy, Srinivas B.; Rai, Maneesh K.; Karur, Satish; Dwarakprasad, Ramesh; Nanjappa, Manjunath C.

In: Journal of Invasive Cardiology, Vol. 24, No. 12, 01.12.2012, p. 675-678.

Research output: Contribution to journalArticle

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AU - Shankarappa, Ravindranath K.

AU - Math, Ravi S.

AU - Chikkaswamy, Srinivas B.

AU - Rai, Maneesh K.

AU - Karur, Satish

AU - Dwarakprasad, Ramesh

AU - Nanjappa, Manjunath C.

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N2 - BACKGROUND: Isolated interruption of the inferior vena cava (IVC) is a rare anomaly. We report a series of 4 cases of isolated interruption of the IVC that coexisted with rheumatic mitral stenosis. Interrupted IVC precludes the use of the femoral approach to percutaneous transseptal mitral commissurotomy (PTMC). We describe the jugular approach to PTMC in such cases using conventional PTMC equipment. METHODS AND RESULTS: The mean pre-PTMC mitral valve area was 0.85 cm2. Septal puncture was done through the right internal jugular vein with a pediatric Brokenborough needle (Medtronic) using the levophase of pulmonary artery angiogram and the pigtail as guide. The mitral valve was crossed successfully in all cases and appropriately sized Accura balloons (Vascular Concepts) were used for incremental dilatations. Successful balloon dilatation was achieved in all 4 cases (mean post-PTMC mitral valve area of 1.85 cm2) with no complications. CONCLUSION: The jugular approach appears to be a safe and effective alternative in cases of rheumatic mitral stenosis with IVC anomalies, thereby preventing an otherwise necessary surgery.

AB - BACKGROUND: Isolated interruption of the inferior vena cava (IVC) is a rare anomaly. We report a series of 4 cases of isolated interruption of the IVC that coexisted with rheumatic mitral stenosis. Interrupted IVC precludes the use of the femoral approach to percutaneous transseptal mitral commissurotomy (PTMC). We describe the jugular approach to PTMC in such cases using conventional PTMC equipment. METHODS AND RESULTS: The mean pre-PTMC mitral valve area was 0.85 cm2. Septal puncture was done through the right internal jugular vein with a pediatric Brokenborough needle (Medtronic) using the levophase of pulmonary artery angiogram and the pigtail as guide. The mitral valve was crossed successfully in all cases and appropriately sized Accura balloons (Vascular Concepts) were used for incremental dilatations. Successful balloon dilatation was achieved in all 4 cases (mean post-PTMC mitral valve area of 1.85 cm2) with no complications. CONCLUSION: The jugular approach appears to be a safe and effective alternative in cases of rheumatic mitral stenosis with IVC anomalies, thereby preventing an otherwise necessary surgery.

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