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Frugal innovation in the cardiac catheter laboratory: Retrograde balloon mitral valvuloplasty using extra back-up guide catheter.

ABSTRACT: Conventional antegrade balloon mitral valvuloplasty is not possible or better avoided in certain clinical situations. Retrograde balloon mitral valvuloplasty is a purely arterial technique designed to avoid complications of atrial septal puncture. We report a case of rheumatic heart disease with severe mitral stenosis and large atrial septal aneurysm where balloon mitral valvuloplasty was performed retrogradely with innovative use of routinely available cardiac catheter laboratory hardware instead of specialised hardware required for such cases. .

SUBMITTER: Malviya A

PROVIDER: S-EPMC6718940 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundIn recent years, the retrograde approach has become a common practice in the treatment of chronic total occlusion (CTO) of coronary ostium which is arising abnormally and has an ambiguous proximal cap. In this case report, we report a case of retrograde percutaneous coronary intervention (PCI) done successfully on an abnormally originating artery which was guideliner assisted. Case Presentation. A 65-year-old gentleman with a history of hypertension, diabetes, and PCI presented to us with angina. Physical examination, electrocardiography (ECG), and echocardiography were done. Coronary angiography (CAG) revealed a normal left anterior descending artery (LAD), an anomalous circumflex (CX) artery arising from the right cusp. The abnormal CX had an implanted stent from which the abnormal right coronary artery (RCA) was arising and had a CTO. It also revealed the retrograde filling of distal RCA through grade 2 Werner collateral channels (CCs) from the LAD, a long CTO segment with a distal cap at the bifurcation. PCI of an RCA-CTO was scheduled utilizing a primary retrograde strategy, since antegrade ostium was abnormal in origin, and the patient was previously stented across the origin. The retrograde wire was externalized, and the procedure was completed with 3 overlapping drug-eluting stents (DESs). We used a guideliner which also assisted in the capture of retrograde corsair during the retrograde procedure of CTO [assisted reverse controlled antegrade and retrograde tracking (CART)]. These measures helped us to complete the CTO intervention successfully.ConclusionThe antegrade crossing is the most common approach to CTOs. However, it is sometimes difficult to penetrate the proximal hard ambiguous cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe an iteration of reverse CART technique using a guide extensor catheter to facilitate externalizing the retrograde wire from false to true lumen.

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Frugal innovation in the cardiac catheter laboratory: Retrograde balloon mitral valvuloplasty using extra back-up guide catheter.

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