The efficacy, safety, and cost of percutaneous mitral commissurotomy (PTMC), using variable volume dependent sized catheters, compared a triple lumen (Inoue) with a double lumen (Accura) catheter. PTMC was performed using Accura balloons in 400 patients and Inoue balloons in 512 patients. The group demographics, increase in mitral valve area, and incidence of significant complications were similar. The catheters were similar with respect to maneuverability and procedure (fluoroscopy) time. The Accura balloons could be reutilized statistically more often (6.3 ± 1.4 for Accura and 5.2 ± 0.8 for Inoue, P < 0.05). Accura balloons were more cost‐effective, with 6.3 usages lowering the per procedural catheter cost to $214.00, while the Inoue balloons, with 5.2 usages, had a final catheter cost of $395.00. The potential savings would have been $155,340.00 if Accura balloons were utilized. Conclusions: Accura and Inoue mitral valvuloplasty balloons were comparable with regard to efficacy and safety, but the Accura balloon was significantly less costly and is therefore more suitable for use in India and other nations where resources are limited.

Objective To analyze the echocardiographic and operative findings with respect to mitral valve anatomy in individuals undergoing emergency surgery for acute severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV). In addition, the clinical profile and outcomes are highlighted. Background Acute severe MR is a major complication of BMV. There are only a few reports which have studied the echocardiographic and operative findings in this setting. In addition, optimal timing of surgery is uncertain. Methods Prospective study of 50 consecutive patients undergoing emergency mitral valve replacement (MVR) for acute severe MR following BMV. Results In 3855 patients who underwent BMV, acute severe MR developed in 50 cases (1.3%) and was referred for emergency MVR. Hypotension (72%), hypoxia (64%), orthopnea (14%), and pulmonary edema (12%) were the clinical manifestations. Severe MR was secondary to anterior mitral leaflet tear in 36 cases (72%), paracommisural tear with annular involvement in seven cases (14%), posterior mitral leaflet tear in five cases (10%) and chordal tear in two cases (4%). The correlation between two‐dimensional transthoracic echocardiography (2D‐TTE) and operative finding for mitral valve calcification was found to be strong (r = 0.862), in contrast to submitral fusion, where it was found to be moderate (r = 0.536). In‐hospital mortality was 12%. Mortality was higher in patients whose time to surgery was ≥24 hr when compared to those who underwent MVR within 24 hr (P < 0.001). Conclusions Hypotension and hypoxia are the predominant manifestations of acute severe MR following BMV. Anterior mitral leaflet tear is the most common etiology for severe MR. 2D‐TTE underestimated the severity of submitral disease. Early MVR (<24 hr) is recommended for optimal outcome. © 2012 Wiley Periodicals, Inc.

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