Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Case Report

Volume 8, Number 4, April 2016, pages 351-355

Percutaneous Mitral Valvotomy in a Case of Situs Inversus Totalis and Juvenile Rheumatic Critical Mitral Stenosis: Case Report

Figures

Figure 1.
Figure 1. ECG (A); chest X-ray (B) PA view showing situs inversus totalis; subcostal echo showing situs inversus (C), critical MS by PHT (D), planimetry (E), post-PTMC MVA-2.0 cm2 (F).
Figure 2.
Figure 2. J-tip guide wire into the left-sided superior vena cava (A), 8F Mullins sheath into the left SVC (B); Brockenbrough needle oriented to 9 o’clock position (C); septal puncture (D).
Figure 3.
Figure 3. 14F dilator across the septum (A); accura balloon into LA over looped wire (B); director inside the balloon (C); balloon towards mitral valve (D).
Figure 4.
Figure 4. Accura balloon entering into the LV (A); distal inflation of balloon (B); mitral valve dilation (C).

Table

Table 1. Summary of Technical Modifications for PTMC in Dextrocardia
 
StepsConventional PTMCPTMC in dextrocardia
Trans-septal catheterizationRight groinLeft groin
Descent of needle assembly4 - 6 o’clock position7 - 9 o’clock position
Septal punctureAP viewPseudo AP view
LAO viewRAO view
Crossing of mitral valve and balloon dilatationRAO viewLAO view