Joseph balloon mitral valvuloplasty is a single balloon procedure for severe symptomatic mitral stenosis. We present a case where difficulty was encountered in advancing the balloon catheter across the mitral valve by standard technique. As the left atrium was grossly dilated, every time the balloon was tracked over the 0.035" extra support wire placed in left ventricle, the wire prolapsed into left atrium. A modified method wherein the balloon was maneuvered into left ventricle with the support of 14F long introducer sheath is presented. This step is useful to complete balloon mitral valvuloplasty successfully in subset of patients with giant left atrium.
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