Re-intervention percutaneous balloon mitral valvuloplasty in a patient with left atrial appendage thrombus: a case report

Abstract

Background Percutaneous Balloon Mitral Valvuloplasty (PBMV) using an Accura balloon is an effective method for management of rheumatic mitral stenosis. Case Summary Herein, we present a case of a 43-year-old female, who had undergone a previous PBMV, who presented with very severe mitral re-stenosis with type Ia left atrial (LA) clot, in atrial fibrillation and New York Heart Association (NYHA) functional class-III. We used the modified septal puncture and over the wire technique, avoiding inadvertent manipulation of the LA clot for PBMV. The mitral valve was successfully dilated from 0.9 cm2 to 1.5 cm2 and patient had an uneventful post procedure recovery. Discussion The presence of LA clot and mitral restenosis in a previously intervened valve are considered unfavourable characteristics for a PBMV procedure, and patients are usually advised surgical intervention. These patients are also high risk candidates for surgery due to late presentation with advanced disease and poor functional capacity. Our patient underwent successful re-intervention with PBMV despite having suboptimal characteristics.