Background: Since the introduction of the Inoue technique for percutaneous balloon mitral valvuloplasty (PBMV), various criteria have been proposed for ideal balloon sizing. In routine practice, balloon size is chosen based on the patient's height according to a simple formula. We tried to define a simple and practical echocardiographic measure for adjusting balloon catheter size to achieve better success rates and fewer complications. Methods: Patients with moderate to severe mitral stenosis who were candidates for PBMV were selected. Maximal mitral commissural diameter at a fully opened state during diastole was measured by transthoracic echocardiography and compared with the values from the height-based formula. Data were compared by paired sample t-test. Results: Eighty-three patients (mean age 45±13.2 years; 77 female) participated. The median balloon size was 28mm (standard deviation [SD] 1.2) according to the height-based formula and 26mm (SD 1.6) according to echocardiography (p<0.001). Using a Bland-Altman plot, an excellent agreement was observed between the two methods. Regression models were fitted to estimate the balloon size using the patients' height, commissural diameter, and mitral valve score. Conclusion: Selection of balloon size according to echocardiographic commissural diameter is a good alternative method. Assuming the possible discrepancy between height-based and commissural-based estimated balloon sizes in some cases, adjustment of balloon sizes according to the maximal commissural diameter may result in acceptable results and fewer complications.

Background: Percutaneous balloon mitral valvuloplasty is the preferred therapeutic strategy in patients with mitral stenosis, but it has shortcomings in a subset of patients. Hypothesis: A new method of balloon sizing through echocardiographic measurement of the intercommissural diameter would be safe and effective and lead to better outcomes. Methods: Eighty-six mitral-stenosis patients were randomly assigned to undergo balloon mitral valvuloplasty either with height-based balloon reference sizing (HBRS group, n = 43) or with balloons sized by the echocardiographic measurement of intercommissural diameter (EBRS group, n = 43). Postprocedural mitral valve area (MVA) and severity of mitral regurgitation (MR) were assessed via echocardiography and ventriculography. Intention-to-treat approach was applied for the statistical analysis. Results: Baseline characteristics were not different between the groups. The mean of the estimated balloon reference sizes was significantly higher in the HBRS patients than in the EBRS group (26.4 ± 0.92 mm, 95% confidence interval [CI]: 26.2-26.6 vs 24.5 ± 1.03 mm, 95% CI: 24.2-24.7, respectively; P = 0.006). Final MVAs were significantly larger in the EBRS group (1.5 ± 0.2 cm 2 , 95% CI: 1.46-1.59 vs 1.4 ± 0.2 cm 2 , 95% CI: 1.35-1.47, respectively; P = 0.01). The occurrence of new or aggravated MR was significantly lower in the EBRS group as assessed both by echocardiography (P = 0.04) and ventriculography (P = 0.05). Mitral regurgitation was aggravated in 13 (29.3%) patients in the HBRS group and in 5 (11.5%) patients in the EBRS group. Conclusions: Percutaneous balloon mitral valvuloplasty via the Inoue technique using balloons sized by the echocardiographic measurement of the maximal commissural diameter is an effective and safe method that might lead to an acceptable increase in the MVA and significant decrease in the rate and severity of iatrogenic MR.

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Background:Little is known about the natural history of aortic regurgitation (AR) in patients undergoing mitral valve procedures for mitral stenosis.Objectives:The aim of this study was to evaluate the short- and long-term effects of percutaneous mitral valvuloplasty (PMV) on coexisting AR.Materials and Methods:A total of 327 patients with rheumatic mitral stenosis (282 females and 45 males; mean age at the time of intervention = 47 ± 11 years) were followed up for between 48 hours and 13 years after PMV. At the time of PMV, 142 (43.3%) patients had no AR, 124 (37.9%) had mild AR, and 61 (18.7%) had moderate AR. After PMV, the follow-up showed that 120 (36.6%) patients had no AR, 103 (31.5%) had mild AR, and 104 (31.8%) had moderate AR.Results:AR progression after PMV and during the follow-up was significant (P < 0.00), but there was no significant increase in aortic valve replacement (AVR) procedures. The rate of AVR was higher in the moderate AR group (3.8%). There were no significant changes in the left atrial size (LA) (P = 0.6), ejection fraction (EF) (P = 0.4), and rhythm (P = 0.4) before and after PMV, respectively.Conclusions:Our findings indicate that among patients with rheumatic mitral stenosis, a considerable number have concurrent AR. Concomitant AR at the time of PMV does not influence procedural success and is not associated with inferior outcomes. Rheumatic aortic insufficiency progresses slowly by nature, and patients with AR and mitral stenosis can safely tolerate PMV without the possibility of undergoing AVR in the near future. Patients with moderate degrees of AR remain good candidates for PMV.