Percutaneous transvenous mitral commissurotomy without heparin

Six hundred and twenty-nine patients with rheumatic mitral stenosis in normal sinus rhythm underwent percutaneous transvenous mitral commissurotomy (PTMC) by the standard Inoue balloon technique. All patients underwent transthoracic echocardiography, when necessary, transesophageal echocardiogram was done before PTMC to exclude left atrial clot. In all cases, the PTMC procedure was completed without administration of heparin. There was no incidence of embolism either in the immediate post-procedure period or at a median follow up of 3 months. There were no femoral artery or venous complications in any of the cases. We conclude that the conventional use of heparin during PTMC may not be required in patients with sinus rhythm and no left atrial clot.