Percutaneous double-valve balloon valvotomy for multivalve stenosis: Immediate results and intermediate-term follow-up

Late results of combined percutaneous balloon valvuloplasty of mitral and tricuspid valves

“…Konugres et al [9] have reported successful percutaneous balloon valvuloplasties of the mitral, aortic and tricuspid valves in rheumatic trivalvular stenoses. However, late results of multiple valve valvuloplasty are only reported recently by Sharma et al [10] and in their 10 combined tricuspid and mitral valvuloplasty patients none had restenosis.…”

“…We used slightly larger balloons for the tricuspid valve than that used for the mitral valve for each patient and if the immediate tricuspid gradient necessitated, a larger size balloon was used. Sharma et al, after experiencing severe TR in one patient, routinely measured the tricuspid valve annulus angiographically to determine the optimal balloon size for the tricuspid valve and they did not experience any other severe TR thereafter [10]. In their 30 month follow up none of their patients had tricuspid valve restenosis.…”

Transjugular approach to concurrent mitral-aortic and mitral-tricuspid balloon valvuloplasty

“…However, dilating the mitral valve first has potential disadvantages. Sharma et al [12] pointed out that if severe mitral regurgitation were to occur, it would lead to a catastrophic situation in the presence of unrelieved aortic stenosis. Berman et al [4], reporting on a series of elderly patients, stated that increased diastolic left ventricular filling in the presence of unrelieved aortic stenosis could increase wall stress and possibly cause subendocardial ischemia.…”

“…Dilating the aortic valve first can also be disadvantageous. Sharma et al [12] reported a patient with mitral valve area 0.4 cm 2 who went into acute pulmonary edema during aortic valve dilatation and was subsequently unable to lie supine.…”

“…If femoral guidewires are positioned in the right ventricular apex [13,27], they are coaxial with the tricuspid orifice but may not give adequate support to the balloon if the right ventricle is small. The Inoue balloon has been used successfully in tricuspid valvuloplasty [5,12], but crossing the tricuspid valve with this balloon from the femoral approach may necessitate an over-the-wire approach [28] or other manipulation [29]. The jugular approach could potentially simplify tricuspid valve crossing with the Inoue balloon and allow coaxial orientation with the tricuspid valve orifice.…”