Percutaneous balloon valvuloplasty in mirror-image dextrocardia and rheumatic mitral stenosis

A 28-year-old woman with mirror-image dextrocardia and severe rheumatic mitral stenosis underwent successful percutaneous balloon mitral valvuloplasty (PBMV). Standard technique was altered to include transseptal catheterization via the left femoral vein and inter-atrial septal puncture with the transseptal needle rotated to a 7 o'clock position. The predilatation transmitral gradient (mean) of 16 mmHg decreased to 5 mmHg following PBMV. The valve area improved from 1.0 cm2 to 2.6 cm2. There were no complications. This case illustrates that transseptal catheterization can be accomplished safely in patients with unusual cardiac anatomy and mitral valvuloplasty can be performed in patients with mirror-image dextrocardia and rheumatic mitral stenosis.