Balloon mitral valvuloplasty: our experience with a modified technique of crossing the mitral valve in difficult cases.

The efficacy and safety of percutaneous transvenous mitral commissurotomy performed by the Inoue technique is well known. In cases with critical mitral stenosis and when there is abnormal bulge of the interatrial septum, the usual direct method of crossing the mitral valve may not be successful. In such cases alternative over-the-wire techniques to cross the mitral valve have been advocated by various authors. In this report of 32 cases, we present our experience with the modified and simplified version of over-the-wire technique of crossing the mitral valve in technically difficult cases. This technique involves direct positioning of a pigtail Inoue wire into the left ventricle through the Mullin sheath followed by introduction of an Inoue catheter over the wire. The mitral valve could be crossed in 30 cases (93.75%). There were no major complications attributable to this technique. Frequent ventricular premature beats (100%) and episodes of nonsustained ventricular tachycardia (90%) were seen in most of the cases. We conclude that our modification of the over-the-wire technique is safe, effective, and does not require any additional accessories. Using this technique, percutaneous transvenous mitral commissurotomy could be performed, even in difficult cases wherein the conventional method of crossing the mitral valve has failed.