PMC5067793_01
Plain X-ray of the thoracolumbar spine taken in anteroposterior view showing severe scoliosis.
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Severe scoliotic deformity of the thoracolumbar spine was seen on plain radiography (Fig. 1).
(A) Levophase of pulmonary angiogram in right anterior oblique projection outlining the left atrium; the optimal site for transjugular septal puncture is marked by an asterisk. (B) A 14F 30-cm-long jugular sheath has been advanced into the left atrium over a curved wire. (C) Transjugular mitral valvuloplasty using an over-the-wire balloon; arrowheads mark the indentation produced on the balloon by the stenotic mitral valve.
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Pulmonary angiography in 45  right anterior oblique projection was performed to obtain a levophase image of the left atrium (Fig. 2A). The optimal site of transjugular septal puncture (Fig. 2A) is higher than that for transfemoral BMV - it is superior to the fossa ovalis, about 2 cm (one vertebral body height) below the upper border of the left atrium and midway between the aorta anteriorly and the anterior border of the spine posteriorly. A 20-cm-long 14 French J-shaped sheath with hemostatic valve (Cook) was advanced into the left atrium over the 0.025-in. guidewire (Fig. 2B). Mitral valvuloplasty was performed (Fig. 2C) using a 24 mm x 40 mm Jomiva balloon (Numed, Hopkinton, NY, USA) which has a 11-French 100-cm-long catheter shaft.