Concurrent balloon dilatation of tricuspid and calcific mitral valve in a patient of rheumatic heart disease.

Concurrent percutaneous balloon dilatation of the mitral and tricuspid valve was performed in a 21-year-old female with severe rheumatic calcific mitral stenosis and severe tricuspid stenosis. The mean gradient across the mitral valve decreased from 30 mm Hg to an immediate post-dilatation level of 14 mm Hg and the mitral valve area increased from 0.71 cm2/m2 to 1.2 cm2/m2. The mean gradient across the tricuspid valve decreased from 11.5 mm Hg to 5 mm Hg. Hemodynamic improvement was maintained at a repeat study performed eight days later. Palliative balloon dilatation of two valves, concurrently performed, thus saved the patient from an open heart procedure and a possible valve replacement.