PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY (PTMC) THROUGH PATENT FORAMEN OVALE (PFO) A NOVEL APPROACH

Objective: To evaluate the safety and efficacy of percutaneous transvenous mitral commissurotomy (PTMC) via patent foramen ovale (PFO) in patients with severe mitral stenosis (MS). Material and Methods: All patients underwent trans-thoracic and trans-esophageal echocardiogram before PTMC. Patent foramen ovale was probed with assembly pointing posteriorly, a little below aortic valve in lateral view. If access to the left atrium could not be gained, transeptal puncture with Bronkenbrough needle was performed and the rest of the PTMC performed with standard Inoue balloon. Results: Out of 500 patients 370 (64%) were females and 130 (36%) were males. The mean age was 27.51+ 7.82 years. PFO was probed and crossed in 435/500 (87%) patients. All PFOʹs were crossed within 15 + 04 minutes of commencement of probing. Spending a longer time searching for PFO did not increase the yield. Mean valve area was 0.86 + 0.19 cm2, which increased to 1.86 + 0.17 cm2 immediately after PTMC (p <0.05). The mean mitral valve gradient decreased from 17 + 4.04 mmHg to 6.8 + 0.25 mmHg immediately after PTMC (p <0.005). No pericardial effusion/tamponade observed in PFO group. The time to cross mitral valve was significantly reduced while accessing through PFO as compared to interatrial septal puncture. Conclusion: PTMC performed via patent foramen ovale is safe. It associated reduces the time of the procedure and complications.