Percutaneous mitral valvotomy using inoue and double balloon technique: Comparison of clinical and hemodynamic short term results in 350 cases

Abstract

The results of percutaneous mitral valvotomy (PMV) by double balloon (N = 230, Group I) and Inoue single balloon (N = 120, Group II) technique were compared. The groups were similar with respect to baseline characteristics. Following PMV there were marked symptomatic and haemodynamic benefits in both the groups. There was significant increase in mitral valve area (MVA) estimated by Gorlin's equation (Group I: from 0.83 +/- 0.18 cm2 to 2.10 +/- 0.45 cm2, p < 0.001; Group II: from 0.83 +/- 0.17 cm2 to 2.16 +/- 0.39 cm2, p < 0.001) and by echoplanimetry (Group I: from 0.84 +/- 0.18 cm2 to 1.91 +/- 0.35 cm2, p < 0.001; Group II: from 0.88 +/- 0.17 cm2 to 1.96 +/- 0.30 cm2, p < 0.001). However, the percentage increase in MVA in the two groups by echoplanimetry (Group I: 136 +/- 59; Group II: 130 +/- 51; p = NS) and by Gorlin's equation (Group I: 164 +/- 69; Group II: 168 +/- 61; p = NS) were not statistically significant. Results were considered optimal when increase in MVA was > or = 1.5 cm2, percentage increase was > or = 50, and mitral regurgitation was < 2/4. Out of 216 patients in Group I where PMV could be performed, optimal results were achieved in 184 (85.2%) by Gorlin's equation and 178 (82.4%) by echoplanimetry. In Group II, out of 116 patients, optimal results were achieved in 107 (92.2%) by Gorlin's equation and 103 (89%) by echoplanimetry. Incidence of mitral regurgitation although higher in Group II (24.1% vs. 18.9%) was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Editorial comment: Cardiac perforation and tamponade: Being at the wrong place but at predictable times during balloon mitral commissurotomy

“…Thus, the early recognition of cardiac perforation may prevent the development of cardiac tamponade, especially before advancement of the introducer or balloon catheter itself and before anticoagulation has begun. On the whole, the incidence of cardiac perforation or tamponade in this study (1.7%) is within the range reported from other large series [2][3][4].Although the authors of this study have carefully evaluated the mechanism of cardiac tamponade in their series of patients, the results of their multivariable analysis seem less useful. Because of the small number of events of cardiac tamponade, the number of variables that can be analyzed with adequate statistical power is very limited.…”

Percutaneous balloon mitral valvuloplasty: Are chinese and western experiences comparable?

“…Because of the potential teratogenic risk from irradiation, PBMV should be carried out after 20 weeks gestation [ 171 with total abdominal and pelvic shielding. The Inoue balloon catheter technique is the procedure of choice, because it takes less time to perform [17,18,21,22,[27][28][29]31,33,35] and thus subjects the fetus to less X-ray exposure than the double-balloon technique [54].…”

Percutaneous mitral valvuloplasty in patients with low cardiac output at high surgical risk

“…The Inoue balloon technique was preferred over the double balloon technique because the former is simpler and quicker [6]. The procedure time in the present study averaged 30 min.…”