Background Percutaneous transvenous mitral commissurotomy (PTMC) is the standard of treatment for symptomatic severe rheumatic mitral stenosis (MS). PTMC has the standard Inoue technique, but we have to modify the procedure in many technically challenging cases, especially to cross the mitral valve. Methodology Two over-the-wire strategies to enter the LV were taken in 80 complex cases of PTMC. The first one was done by exchanging the J-shaped wire from the balloon, introducing the spring wire into it, and pushing it into LV. The second one-removal of balloon keeping the spring wire in LA and the Mullin's sheath was introduced, and the tip of the wire was pushed into LV, and the balloon was introduced over the wire. We also changed the left atrium (LA) graphy in the RAO view instead of the AP view to facilitating entry into LV. Results We succeeded in 76 (95 %) cases. Strategy one was applied to all but successful in only 25 cases (31 %), and strategy 2 was applied in the remaining. Strategy 1 required less procedural time and fluoroscopic time in comparison to strategy 2 (40 ± 10 vs 60 ± 16 min, 25 ± 7 vs 35 ± 8 min). After modification of taking the LA graphy in RAO view, our rate of facing the difficulties decreased from 21 % to 9 %. Critical MS (31 %) and the giant LA (30 %) were the topmost causes of difficulties. No major complications were recorded. Conclusion Over-the-wire entry into LV is cost-effective, requiring no new equipment and is safe and can be used in complex cases.

Certain congenital heart defects require the creation of an unrestrictive atrial septal defect (ASD) secundum to achieve adequate atrial mixing to improve systemic oxygen saturation by placing septal stent. We reported a case of 7-month-old child who was presented with shock like state with marked desaturation. He was diagnosed as a case of mixed total anomalous pulmonary venous return with restricted closing ASD secundum. We performed atrial septal stenting as a palliative procedure for saving the life. Creation or enlargement of ASD in infants using nonconventional transcatheter techniques is feasible, safe, and effective when usual technique fails or not suitable. After the procedure systemic saturation improved and patient became hemodynamically stable and there after rerouting of pulmonary veins to left atrium with ASD closure and removal of stent done by open heart surgery and send him home safely. Cardiovasc. j. 2020; 13(1): 86-91

Nephrotic syndrome is a common renal problem in children. But it is an uncommon complication for cyanotic heart diseases. It has been rarely reported in pediatric population with congenital cyanotic heart disease in Bangladesh. We found two cases of congenital cyanotic heart disease those were referred to investigate for nephrotic range of proteinuria. Bangladesh J Child Health 2020; VOL 44 (3) :178-180

Rupture sinus of Valsalva (RSOV) is an uncommon condition with a wide spectrum of presentation, ranging from an asymptomatic murmur to cardiogenic shock or even sudden cardiac death. Our case presented at 62 yrs with progressive onset of dyspnea, palpitation with deterioration of exercise capacity. Diagnosis of ruptured sinus of Valsalva was made by echocardiography, it was aneurysmal and opened into right ventricular outflow tract. Coronary artery disease was excluded by coronary angiogram. Probable cause of rupture was atherosclerosis.We closed percutaneously with ADO I device. The procedure was completed uneventfully. Patient discharged with duel antiplatelet and is on follow up. Bangladesh Heart Journal 2020; 35(2) : 155-158

24 year old young lady came to us with a diagnosis of atrial septal defect (ASD) secundum who lost her follow up since her 4 years of age. Later her history, physical findings and investigations change the diagnosis into supracardiac total anomalous pulmonary venous drainage. Typical ‘snowman sign’ in chest x-ray and transthoracic echo helped to review the case. Proper history taking and careful evaluation by investigation is needful for each individual. Cardiovasc. j. 2019; 12(1): 75-78