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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:BackgroundResults of percutaneous balloon mitral valvuloplasty (BMV) are basically dependent on suitable patient selection. Currently used two-dimensional (2D) echocardiography (2DE) scores have many limitations. Three-dimensional (3D) echocardiography (3DE)-based scores were developed for better patient selection and outcome prediction. We aimed to compare between 3D-Anwar and 2D-Wilkins scores in mitral assessment for BMV, and investigate the additive value of 3DE in prediction of immediate post-procedural outcome. Fifty patients with rheumatic mitral stenosis and candidates for BMV were included. Patients were subjected to 2D- and real-time 3D-transthoracic echocardiography (TTE) before and immediately after BMV for assessing MV area (MVA), 2D-Wilkins and 3D-Anwar score, commissural splitting, and mitral regurgitation (MR). Transesophageal echocardiography (TEE) was also undertaken immediately before and intra-procedural. Percutaneous BMV was performed by either multi-track or Inoue balloon technique.ResultsThe 2DE underestimated post-procedural MVA than 3DE (p = 0.008). Patients with post-procedural suboptimal MVA or significant MR had higher 3D-Anwar score compared to 2D-Wilkins score (p = 0.008 and p = 0.03 respectively). The 3D-Anwar score showed a negative correlation with post-procedural MVA (r = - 0.48, p = 0.001). Receiver operating characteristic (ROC) curve analysis for both scores revealed superior prediction of suboptimal results by 3D-Anwar score (p < 0.0001). The 3DE showed better post-procedural posterior-commissural splitting than 2DE (p = 0.004). Results of both multi-track and Inoue balloon were comparable except for favorable posterior-commissural splitting by multi-track balloon (p = 0.04).ConclusionThe 3DE gave valuable additive data before BMV that may predict immediate post-procedural outcome and suboptimal results.

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