Inoue-Balloon Percutaneous Transvenous Mitral Valvuloplasty through the Left Femoral Vein in Anomalous Inferior Vena Cava

Abstract

Inoue-balloon percutaneous transvenous mitral valvuloplasty is conventionally performed via the right femoral vein. However, atrial transseptal access can be technically challenging. Herein, we describe a 54-year-old male who had balloon mitral valvuloplasty performed via the left femoral vein because of an anomalous inferior vena cava course, including the technical issues encountered using this approach.

Key words: Anomalous inferior vena cava; Left femoral vein approach; Mitral valvuloplasty.

Figure 1

(A) Frontal-view venogram, obtained with contrast medium injected in RIV, through Mullins sheath, showing anomalous IVC course, with RIV drainage into IVC at an acute angle. (B) Fluoroscopic frontal composite view showing guide wire and needle assembly, inserted through LIV to superior vena cava. (C) Frontal view showing transseptal assembly set in right atrium. (D) Tip of dilator catheter/needle (white arrow) at optimal puncture site, namely crossing site of vertical M line and horizontal C line; M line indicates vertical line, intersecting mid-point of horizontal AL line. Point A indicates tip of pigtail catheter in contact with non-coronary sinus of Valsalva) and Point L, left atrial lateral silhouette (white dotted line); (E) 30° right anterior oblique view, showing horizontal line crossing center of mitral annulus (white dotted line). IVC, inferior vena cava; LIV, left iliac vein; RIV, right iliac vein (Refer to text and reference 2 for detail).

Figure 2

Shaping of Brockenbrough needle. (A) Unshape needle. (B) After shaping (refer to text for detail).