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

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. <Learning objective: 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. The retrograde balloon mitral valvuloplasty using EBU (Extra Back-up, Medtronic Inc., Minneapolis, USA) guide catheter and Tyshak II balloon can be alternative to standard retrograde balloon mitral valvuloplasty technique whenever retrograde technique is chosen over antegrade technique.>.