A 20-years-old female with situs inversus dextrocardia underwent successful percutaneous mitral valvuloplasty. We employed the standard Inoue technique with the least number of modifications. The trans-septal puncture needle was rotated to a 7 o'clock position and needle position was confirmed in standard antero-posterior and right lateral views. Mitral valve dilatation was achieved by an Inoue balloon 26 mm. Mitral valve area increased from 1.0 cm² to 1.9 cm² with drop of mean diastolic gradient from 15 to 5 mmHg, and no more than moderate mitral regurgitation. We concluded that trans-septal mitral valvuloplasty can be safely performed in unusual cardiac anatomy.
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The introduction of drug eluting stents (DES) revolutionised the field of interventional cardiology by dramatically reducing the development of late in-stent restenosis (ISR). Stent fracture, however, has recently been suggested as one possible mechanism of restenosis after DES implantation. Here we report the first case of ISR caused by the fracture of overlapping zotarolimus eluting stents in a vigorously moving proximal right coronary artery.
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