• Tariq Asharf
  • Muhammad Anis Memon
  • Syed Ishtiaque Rasool
  • Najma Patel
  • Ziauddin Panhwar
  • Fawad Farooq
  • Tahir Saghir
  • Nadeem Qamar
  • Khan Shah-e- Zaman


Background: Percutaneous mitral valvuloplasty (PMV) is still the treatment of choice in selected cases of mitral stenosis (MS). Multitrack balloon (MTB) catheter is one of the techniques used for PMV with optimal results. We describe a novel refinement of appropriate balloon sizing and wire placement to reduce mitral regurgitation (MR) and Left ventricular (LV) apical perforation, respectively. Methods: Ninety four consecutive patients with moderate to severe rheumatic mitral stenosis (MS) were selected for PMV with MTB catheter. Balloon sizing was done by effective balloon dilatation area (EBDA), using standard geometric formula. 0.35˝ PMV wire was placed in aortic arch /ascending aorta (AA) to avoid LV apical perforation. Results:  Mild MR was present in 28(29.8%). Post-procedure MR was present in 50(53.2%). Out of 50 MR cases 44(88%) had mild and 6(12.0%) had moderate MR. No patient had severe MR. With placement of wire in AA and arch of aorta none of the patients developed complication of LV apical perforation. Conclusion: EDBA as balloon sizing for multitrack system can be used to reduce severity of mitral regurgitation. Placement of PMV guide wire in Aortic arch/AA ascending aorta can eliminate/substantially reduce dreadful complication ofLV perforation.Keywords: Multitrack Balloon Catheter, Balloon Sizing, PMV Guide Wire


Sadiq M, Islam K, Abid R, Latif F, Rehman AU, Waheed A, et al. Prevalence of rheumatic heart disease in school children of urban Lahore. Heart 2009;95(5):353–7.

Hyder AA, Morrow RH, Applying burden of disease methods in developing countries: a case study from Pakistan. Am J Public Health 2000;90:1235-40.

Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O. Status of Rheumatic heart disease in rural Pakistan. Heart 2004;90:394–9.

Faheem M, Hafizullah M, Gul A, Jan H, Khan MA. Pattern of valvular lesions in rheumatic heart disease. J Postgrad Med Inst 2007;21(2):99–103.

Mahmood ul Hasan, Hafizullah M, Gul AM, Jan H, Awan ZA. Percutaneous transvenous mitral commissurotomy (PTMC) through patient foramen ovale (PFO). A novel approach. J Postgrad Med Inst 2008;22(2):148–51.

Sharieff S, Aamir K, Sharieff W, Tasneem H, Masood T, Saghir T, et al. Comparison of Inoue balloon, metallic commissurotome and multi-track double-balloon valvuloplasty in the treatment of rheumatic mitral stenosis. J invasive Cardiol 2008;20:521–5.

Bonhoeffer P, Esteves C, Casal U, Tortoledo F, Yonga G, Patel T, et al. Percutaneous mitral valve dilatation with the Multi-Track System. Catheter Cardiovasc Interv 1999;48(2):178–83.

Roth RB, Block PC, Palacios IF. Predictors of increased mitral regurgitation after percutaneous mitral balloon valvotomy. Cathet Cardiovasc Diagn 1990;20(1):17–21.

Poutanen T, Tikanoja T, Sairanen H, Jokinen E. Normal mitral and aortic valve areas assessed by three-and two-dimensional echocardiography in 168 children and young adults. Paediatric Cardiol 2006;27(2):217–25.

Rediker DE, Guerrero JL, Block DS, Southern JF, Fallon JT, Block PC. Limits of mitral valve apparatus distensibility: Observations from balloon mitral valvotomy in a canine model. Am Heart J 1987;114(6):1513–5.

Lung B, Cormier B, Ducimetier P, Porte JM, Nallet O, Michel PL et al. Immediate results of percutaneous mitral Commissurotomy. A predictive model on a series of 1514 patients. Circulation 1996;94(9):2124–30.

Sherif MA, Khashaba AA, Gomoa Y, Khaled S, Refare O, Ramzy A. Pooled analysis of Percutaneous mitral valvuloplasty in Egypt. Catheter Cardiovasc Interv 2009;73(3):419–25



Most read articles by the same author(s)