Case series: Difficult PTMC using novel technique of veno-arterial looping

Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue/Accura balloon is an effective procedure for management of patients with rheumatic mitral stenosis.(1) Inability to cross the mitral valve is one of the pertinent reasons for procedural failure. We describe a series of three patients who were tackled with successful PTMC using a novel technique of veno-arterial looping and in the fourth patient we used double loop entry into left ventricle with veno-arterial rail and peripheral balloon dilatation for completing the PTMC. This is first such reported case series in literature to our knowledge.