Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2026 01 25 329 331 EN Sriram Veeraraghavan SRM MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTRE, POTHERI,CHENGALPATTU,TAMILNADU,INDIA Bharath Kidambi Mt.Sinai hospital, New York , USA Sandeep Unnikrishnan Karuna Medical college, Perumatty, Kerala Karthikeyan Balakrishnan Hindu Mission Hospital, Tambaram, Chennai, Tamil Nadu, India 2025 10 30 2025 11 25 Percutaneous Transvenous Mitral Commissurotomy (PTMC) remains the standard intervention for rheumatic mitral stenosis in suitable candidates. Conventional septal puncture and balloon entry can occasionally be challenging in cases with distorted left atrial anatomy or unfavorable interatrial septal orientation.In such situations ,the catheter is looped within the left atrium in a reverse configuration. This maneuver redirects the balloon tip toward the mitral orifice, enabling smoother passage across the valve without repeated manipulations or risk of atrial injury.The reverse loop technique provides improved control, reduces procedural time, and minimizes trauma to the atrial wall in anatomically difficult cases. Early procedural success and hemodynamic improvement are comparable to standard PTMC. https://jthc.tums.ac.ir/index.php/jthc/article/view/2385 https://jthc.tums.ac.ir/index.php/jthc/article/download/2385/1239