Balloon Mitral Valvuloplasty in Mirror Image Dextrocardia with Rheumatic Mitral Stenosis with Suprasystemic Pulmonary Arterial Hypertension.

32 years old male with history of mirror image dextrocardia with situs inversus and history of rheumatic fever at age of 12 years on penicillin prophylaxis till 25 years of age presented with history of dyspnea on exertion NYHA class 2 since last five years. Cardiac colour Doppler 5 years back was suggestive of rheumatic mitral stenosis with mitral valve area 2 cm2 with mirror image dextrocardia with mild pulmonary arteriolar hypertension in normal sinus rhythm. Patient was put on medications and was advised regular follow up. Patient did not follow up regularly. Cardiac colour doppler 5 years later showed mitral valve area of 0.8 cm2 with suprasystemic pulmonary arterial hypertension of 130 mmhg . Hence was advised percutaneous balloon mitral valvuloplasty. Balloon mitral valvuloplasty was done successfully without inverting the images on fluoroscopy using left femoral approach. Post balloon mitral valvuloplasty mitral valve area increased significantly with mild mitral regurgitation and regression of pulmonary arterial pressures to half the original values.