Objective: To demonstrate the safety and efficacy of balloon mitral valvuloplasty in patients of rheumatic mitral stenosis and situs inversus with dextrocardia. Background: Distorted cardiac anatomy and cardiac malpositions increase the complications of interatrial septal puncture and left ventricular entry during balloon mitral valvuloplasty. Methods: Five patients with rheumatic mitral stenosis and situs inversus with dextrocardia were included in this study. Mean transmitral gradient before

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... alloon mitral valvuloplasty (18 AE 6 mmHg) was significantly higher, while mitral valve area (MVA) (0.68 AE 0.4 cm 2 ) was significantly lower. All the five patients were young (mean age of 32 years) and symptomatic (mean pulmonary artery pressure 60 AE 10 mmHg). Left femoral venous and arterial approach was used. Fluoroscopic imaging was performed without inverting the images although the software for the same was available. The interatrial septum was approached using fluoroscopy guide with needle directed towards the spine and keeping the pointer of Brockenbrough needle at seven to eight O' clock position followed by transatrial puncture in left lateral view. The transit across the mitral valve was done in left anterior oblique view without using pseudo right anterior oblique imaging with just clockwise or counter clockwise guidewire movement. Simultaneous transthoracic echocardiography guidance was used. Results: Pre and post balloon mitral valvuloplasty hemodynamic parameters were compared. Mean transmitral gradient before balloon mitral valvuloplasty (18 AE 6 mmHg) was significantly higher, while mitral valve area (MVA) (0.68 AE 0.4 cm 2 ) was significantly lower. All the five patients were young (mean age of 32 years) and symptomatic (mean PA pressure 60 AE 10 mmHg. After balloon mitral valvuloplasty, mean PA pressure was significantly reduced -[33.5 AE 12 mmHg], with a significant reduction in transmitral gradient (8.2 AE 3.5 mmHg), with an increase in mitral valve area (2.1 AE 0.6 cm 2 ). Conclusion: This case series demonstrates the safety and efficacy of balloon mitral valvuloplasty without inverting the images on fluoroscopy.