successful reattempt of percutaneous balloon mitral valvotomy using reverse-loop entry technique

Percutaneous transvenous mitral commissurotomy (ptmc) remains the standard intervention for rheumatic mitral stenosis in suitable candidates. conventional septal puncture and balloon entry can occasionally be challenging in cases with distorted left atrial anatomy or unfavorable interatrial septal orientation.in such situations ,the catheter is looped within the left atrium in a reverse configuration. this maneuver redirects the balloon tip toward the mitral orifice, enabling smoother passage across the valve without repeated manipulations or risk of atrial injury.the reverse loop technique provides improved control, reduces procedural time, and minimizes trauma to the atrial wall in anatomically difficult cases. early procedural success and hemodynamic improvement are comparable to standard ptmc.