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.