Percutaneous mitral balloon valvuloplasty. Difficult mitral valve crossing

Introduction Percutaneous mitral balloon valvuloplasty (PMBV) is the treatment of choice for significant mitral stenosis (MS). The inability to cross the mitral valve accounts for a non-negligible rate of unsuccessful PMBV. This may be caused by unfavorable septal puncture or extensive enlargement of the left atrium (LA), both resulting in insufficient support. Advanced valvular and subvalvular degeneration may further impede valve crossing. Surprisingly, only a few reports focus on this problem. In a study by Feldman, failure to cross the mitral valve occurred in 1.7% of cases [1]. Cribier et al. reported the occurrence of this failure at 2.6% [2]. We present a case of a successful re-attempt of PMBV done with the support of a veno-arterial loop after an unsuccessful mitral valve crossing with an Inoue balloon in the first procedure.