Percutaneous transvenous mitral commissurotomy in a patient with prosthetic aortic valve

Patients with rheumatic valvular heart disease who have undergone valve sur gery may present later with progression of disease in other valves. We repo rt a case of successful percutaneous transvenous mitral commissurotomy (PTM C) in a 58-year-old male who underwent aortic valve replacement (AVR) with a No. 23 Bjork-Shiley valve for severe rheumatic aortic regurgitation in 19 82. At AVR, echocardiography revealed mild mitral stenosis WS) and mitral v alve area (MVA) 2.5 cm2. Over 18 years, the mitral valve disease progressed to severe MS and the patient presented with class III exertional dyspnea. He underwent successful PTMC (Inoue balloon technique). Post-procedure echo cardiography revealed a MVA of 2.0cm(2) and grade II mitral regurgitation. Anticoagulation management, infective endocarditis prophylaxis and procedur al modifications are discussed.