Clinical Images

Veno-arterial Loop Aiding Mitral Valve Crossing for Balloon Mitral Valvuloplasty in a Patient With a Huge Left Atrium

Amir Samaan, MRCP(UK), MD1,2;  Michael Nagy, MSc1;  Kerolos Wagdy, MSc1;  Alaaeldin Amin, MD1;  Ahmed El Guindy, MRCP(UK), MD1

Amir Samaan, MRCP(UK), MD1,2;  Michael Nagy, MSc1;  Kerolos Wagdy, MSc1;  Alaaeldin Amin, MD1;  Ahmed El Guindy, MRCP(UK), MD1

J INVASIVE CARDIOL 2018;30(6):E50-E51.

Key words: severe mitral stenosis, valvuloplasty


A 52-year-old woman presented to our center complaining of shortness of breath on minimal effort. Her physical examination showed atrial fibrillation, accentuated first heart sound, and a rumbling murmur over cardiac apex. Echocardiography confirmed the diagnosis of rheumatic severe mitral stenosis with a mitral valve area of 1.1 cm2 and mean pressure gradient of 12 mm Hg across the valve (Figure 1A). With a Wilkin’s score of 8/16 and after exclusion of left atrial appendage thrombus by transesophageal echocardiography, the patient was considered for percutaneous balloon mitral valvuloplasty, which is illustrated in Figures 1B-1F. Post procedure, the resulting mitral valve area was 1.8 cm2, while the mean pressure gradient across the valve dropped to 5 mm Hg. A mild mitral regurgitation was observed and there were no other complications. The patient was kept on beta-blockers and warfarin, and on follow-up, she reported marked improvement of her symptoms.

Veno-arterial loop is a feasible and safe technique to facilitate mitral valve crossing for balloon mitral valvuloplasty in mitral stenosis patients. The technique is particularly beneficial in patients where valve crossing is not possible in the traditional way due to anatomical alterations and hugely dilated left atrium.


From 1Aswan Heart Centre (Magdi Yacoub Heart Foundation), Aswan, Egypt; and 2the Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt.

Disclosure: The author has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The author reports no conflicts of interest regarding the content herein.

Manuscript accepted February 8, 2018. 

Address for correspondence: Amir Samaan, MRCP(UK), MD, Associate Consultant Interventional Cardiology, Aswan Heart Centre (Magdi Yacoub Heart Foundation), Aswan, Egypt. Email: amiranwar82@yahoo.com

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