We report the case of a 51-year-old woman who underwent percutaneous mitral valvotomy using single balloon technique for restenosis after a previous surgical closed commissurotomy. After the procedure, she presented with severe mitral regurgitation and was referred to our center for mitral valve replacement. At surgery, the underlying cause of the mitral regurgitation was shown to be a tear at the commissural site which extended into the annulus. The mitral valve was successfully replaced and the post-operative course was uneventful. One year later the patient is in good clinical condition.
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