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Human heart consists of four chambers and four valves. Mitral stenosis is a condition whereby mitral valve becomes narrowed. It is a long-term complication of rheumatic fever which is becoming rare in the developed world. Rheumatic fever caused by invasive streptococcus infection involving the throat and then causing inflammation of the lining of heart and valves.

There will be no symptoms till the fourth decade. Initial symptoms may be palpitations due to irregular heart rhythm and breathlessness on exertion. Those symptoms may eventually develop to swelling of legs, cough with frothy blood stained sputum, and even stroke due to clot formation of heart.

Once symptoms occur, it is important to perform imaging on the heart to plan for treatment. If the valve stiff due to deposit of calcium salts, surgery is recommended. Alternatively, PTMC (Percutaneous Transvenous Mitral Commissurotomy) or balloon valvuloplastry, is a semi-invasive procedure where a balloon is used to dilate the narrowed mitral valve.

How is PTMC done?

This procedure can only be carried out through the groin approach. Both the femoral vein and artery will be punctured and one sheath will be inserted through each vessel. A long pigtail catheter will be positioned in the left ventricle the same way as a coronary angiogram. Then a long puncture needle will be placed at the right atrium through the femoral vein. A long coil is then passed to the left atrium through the hole punctured. A balloon-tipped catheter (Inoue balloon) is then guided through the hole created to the left atrium and from there passed through the mitral valve.

The Inoue balloon is inflated several times to stretch the narrow segment of the mitral valve. The entire balloon, catheter, coil and other foreign bodies will be removed. The hole created will usually close off by itself. Even if it is not sealed, such a small hole shouldn’t cause any problem to the heart. Patient will need antibiotics before and after the procedure.

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