Percutaneous transvenous mitral commissurotomy following Carpentier ring annuloplasty

Percutaneous transvenous mitral commissurotomy (PTMC) has been performed in a wide variety of patient subsets. Patients with rheumatic and congenital mitral stenosis have been treated with balloon commissurotomy.(1,2) A variety of subgroups including elderly patients,(3) those with calcified mitral apparatus,(4) and pregnant patients(5,6) have also been described. PTMC in patients with a bioprosthetic mitral valve prosthesis(7,8) and with prior surgical commissurotomy(9) have also been reported. This report describes a patient with prior Carpentier ring mitral annuloplasty for rheumatic mitral regurgitation who subsequently developed commissural fusion. This unique clinical setting poses a number of questions regarding the level of the stenosis, the risks of PTMC, and the feasibility of obtaining a successful acute outcome.