New-onset complete right bundle branch block following successful balloon mitral valvuloplasty for mitral stenosis: a new phenomenon?

What is it about?

Balloon mitral valvuloplasty (BMV) is the treatment of choice for severe mitral stenosis. BMV can have complications like severe mitral regurgitation, cardiac perforation leading to cardiac tamponade, embolic events including stroke, vascular complications, arrhythmias and residual atrial septal defect. Right bundle branch block (RBBB) as an iatrogenic cause has been described after ventricular septal defect closure, tetralogy of Fallot repair, right heart catheterisation, coronary artery bypass graft surgery, cardiac transplantation and alcohol septal ablation. RBBB following BMV has not been described in the literature to date. We present a case of severe mitral stenosis who underwent successful BMV. The post-operative course was uneventful except for development of complete RBBB. This is the 1st description of RBBB as a complication of BMV.	Mechanism of RBBB post BMV is elusive but can be due to dislodgement and spread of calcification from valve to right bundle branch during catheter manipulation. Other potential mechanisms could be iatrogenic large ASD, anatomical variation in the conduction pathways resulting in trauma during catheter manipulation, spread of calcification from associated adjacent organic tricuspid valve disease or as yet unclear mechanisms.



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