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HOW TO DO A PERCUTANEOUS TRANS-VENOUS MITRAL COMMISSUROTOMY (PTMC)! DR BINOY JOHN (COMPLETE STEPS)

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• published: 07 May 2016
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HOW TO DO A PERCUTANEOUS TRANS-VENOUS MITRAL COMMISSUROTOMY (PTMC)! DR BINOY JOHN (COMPLETE STEPS) PTMC is a procedure used to split open a narrowed or stenosed Mitral Valve using a balloon. Narrowing of the valve often occurs following a childhood rheumatic fever involvement of the heart valves. PTMC is one of the most challenging procedures in interventional cardiology as the septal puncture with the needle requires immense experience as the anatomy in all mitral stenoses patients are variable due to the differences in the chamber enlargement in each patient. PTMC is done via the leg vein and thus helps to avoid a morbid major open heart surgical procedure as a MITRAL VALVE REPLACEMENT! It is done via a small needle hole puncture in the Femoral vein of the leg. Once the puncture is made a wire is advanced into the left subclavian vein and a Mullin's sheath is advanced into the subclavian vein over the wire. Thereafter a Brockenbrough needle is passed through the sheath to make a puncture in the inter-atral septum at the fossa-ovalis. (This is the most crucial and hazardous step as puncturing any other place in the heart can result in blood rushing out of the heart and causing cardiac tamponade or compression of the heart by blood and death, if not dealt with effectively!) Once the IAS puncture is made, the LA position is confirmed by contrast injection and or pressure measurement in the LA. Then, the Mullin's sheath is advanced into the LA and the BB needle is removed. Then a LA wire is advanced through the Mullin's sheath and then the sheath is removed. the small hole in the IAS is made bigger using a septal dilator. Therafter the balloon is passed over the LA wire and then crossed with a stillette into the Left ventricle of the heart. The balloon inflates in three stages, the distal part first and then the proximal part while the waist inflates last to tear the mitral commissures across the mitral valve, thus providing an excellent result. Mitral regurgitation, especially acute severe MR is one of the complications which can occur but is un-common in experienced hands. The patient is discharged and walks home in 24 hours, which is the beauty of the procedure! DR BINOY JOHN MD DM (CARDIOLOGY) FCSI FACC FESC FSCAI FAPSIC Facebook @ Binoy John Dr