Percutaneous transvenous tricuspid commissurotomy in a patient with congenitally corrected transposition of great arteries: a case report.

Percutaneous balloon tricuspid valvotomy was successfully performed in a 45-year-old female with congenitally corrected transposition of great arteries with severe rheumatic left atrioventricular (tricuspid) valve stenosis. Technical modifications in the standard procedure were made keeping in mind the left-handed ventricular loop, left and anterior aorta, wedged pulmonary valve between the interatrial septum and the mitral valve with deviation of the atrial septum away from the ventricular septum, side-by-side positioned ventricles with an added superoinferior obliquity produced by excessive tilting, and an abnormal orientation of ventricular mass in relation to the thorax, with the apex pointing slightly rightwards. A final valve area of 1.4 cm(2) and a fall in the peak/mean left atrial pressures from 37/32 mm Hg to 13/10 mm Hg were achieved without complications. This case of percutaneous transvenous commissurotomy is unique in view of the rarity of the combination of this congenital heart disease and rheumatic heart disease and successful commissurotomy in such an unusual cardiac anatomy using the Inoue technique.