A comparison of cylindrical and Inoue balloon techniques for mitral valvotomy in patients in the United Kingdom.

Turnbull, Colin M.; Currie, Peter; Flapan, A. D.; Pringle, Steven D.; Lee, B. C.

doi:10.1136/hrt.72.5.486

Cited by 9 publications

(5 citation statements)

References 18 publications

(2 reference statements)

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“…In the initial 16 patients, treated before the Inoue balloon was available in Europe, single or double cylindrical balloons were used. We found these two techniques to have the same haemodynamic outcome21 but there was a shorter procedure time and fewer complications with the Inoue technique. The mean (SD) effective balloon dilatation area22 was 3.5 (0.52) cm 2 /m 2 .…”

Section: Methodsmentioning

confidence: 67%

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Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

Sutaria

Elder²,

Shaw³

2000

Heart

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Objective-To assess the immediate haemodynamic improvement and long term symptomatic benefit of percutaneous mitral balloon valvotomy in patients aged over 70 years. Design-Pre-and postprocedure haemodynamic data and follow up for 1 to 10 years by clinic visit or telephone contact. Setting-Tertiary referral centre in Scotland. Subjects-80 patients age 70 and over who had mitral balloon dilatation: 55 were considered unsuitable for surgical treatment because of frailty or associated disease. In an additional four patients mitral dilatation was not achieved. Main outcome measures-Increase in valve area after balloon dilatation and survival, freedom from valve replacement, and symptom class at follow up. Results-Mean (SD) valve area increased by 89% from 0.84 (0.28) to 1.59 (0.67) cm 2 . There was a low rate of serious complications, with only two patients having long term major sequelae. Of 55 patients unsuitable for surgical treatment, 28 (51%) were alive without valve replacement and with improvement by at least one symptom class at one year, and 14 (25%) at five years. In the 25 patients considered suitable for surgical treatment, 16 (64%) achieved this outcome at one year and nine (36%) at five years. Conclusions-Percutaneous mitral balloon valvotomy is a safe and useful palliative procedure in elderly patients who are unsuitable for surgery. Balloon dilatation should also be used for elderly patients whose valve appears suitable for improvement by commissurotomy, but echo score is an imperfect predictor of haemodynamic improvement. (Heart 2000;83:433-438)

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Section: Methodsmentioning

confidence: 67%

“…15 Echo scoring was by consensus of two observers and was done prospectively in 59 patients and retrospectively from video recordings in the first 21 patients. The latter 53 patients (66%) also had a transoesophageal echo (TOE) study21immediately before the planned procedure. In 17% of these patients left atrial thrombus was detected.…”

Section: Methodsmentioning

confidence: 99%

Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

Sutaria

Elder²,

Shaw³

2000

Heart

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“…The causes of failure to complete balloon dilatation were failed transseptal puncture (2), intensive vasovagal reaction at transseptal puncture (1), balloon unable to cross the mitral orifice (5), haemopericardium (2), and stroke from dislodged atrial thrombus (1). The success rate for completed valvotomy using the Inoue balloon was 99%, and with cylindrical balloons-used before the Inoue equipment was available in the UK 11 -it was 91%.…”

Section: Methodsmentioning

confidence: 99%

“…14 We found these two methods gave the same haemodynamic result. 11 Right and left heart pressures were recorded using 10 cm above the table as zero. Mean valve gradient was measured by planimetry.…”

Section: Percutaneous Mitral Balloon Valvotomymentioning

confidence: 99%

Clinical and haemodynamic profiles of young, middle aged, and elderly patients with mitral stenosis undergoing mitral balloon valvotomy

Sutaria¹,

Prendergast²

2003

Heart

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Objective: To compare the clinical characteristics, haemodynamic findings, and symptomatic outcome in four age groups of patients in the UK undergoing percutaneous mitral balloon valvotomy. Design: A review of patients with mitral stenosis treated by balloon dilatation. Setting: Western General Hospital, Edinburgh, a cardiac referral centre. Results: Of 405 patients who had mitral balloon valvotomy, 19 were aged under 40 years, 101 aged 40-54, 173 aged 55-69, and 112 were 70 years old or more. Medical co-morbidity and Parsonnet score for risk at surgery increased notably with age. Older patients had greater symptomatic limitation and a more severe degree of mitral stenosis, with more valve degenerative change. The incidence of atrial fibrillation, mitral reflux, left ventricular impairment, coronary artery disease, and aortic valve disease increased progressively with age. Before balloon dilatation the right ventricular systolic and left atrial pressures were similar in all age groups, but younger patients had a higher transmitral gradient and cardiac output. After balloon dilatation the younger patients achieved a greater increase in valve area. Complications of balloon valvotomy were more common in the older patients. At five years after balloon dilatation the percentages of patients in each age group who were in New York Heart Association classes I and II were 87%, 63%, 36%, and 19%, respectively. Mortality at five years was 0%, 5%, 31%, and 59%. Conclusions: Percutaneous balloon valvotomy gives a good haemodynamic and symptomatic result in patients under 55. In older patients improvement is often less pronounced and less sustained, but the procedure is a well tolerated palliative treatment for those unsuitable for surgery.

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“…16 Inoue balloon dilatation for rheumatic heart disease was more successful than the over-wire balloon technique. 17 Nevertheless, the suitability of the Inoue balloon for individuals with calcific mitral stenosis is questioned, primarily due to difficulties in attaining optimal left ventricular positioning and concerns regarding mitral valve injury during multiple valve recrossings.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous balloon mitral valvuloplasty with shockwave lithotripsy for the treatment of calcific mitral valve stenosis

Alnasser,

Moey,

Ali

et al. 2024

Cathet Cardio Intervent

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BackgroundCalcific mitral stenosis (calcific MS) presents a challenge for surgical treatment and is a contraindication for most contemporary transcatheter mitral valve replacement devices (TMVR), rendering patients with very limited therapeutic options.AimsThis study aims to assess the clinical and hemodynamic follow‐up after mitral valve lithotripsy (MVL).MethodsAll consecutive patients who underwent MVL to treat symptomatic calcific MS at St Michael's Hospital, Toronto, Canada, were included. Patients were deemed unsuitable for mitral surgery or TMVR after heart team assessment. Patients with rheumatic MS or ≥moderate mitral regurgitation (MR) were excluded. The primary endpoint was a reduction in the invasive mitral gradient by ≥50% without significant (≥moderate) MR.ResultsFifteen patients underwent MVL between 2021 and 2023 with a mean age of 74 ± 9 years; 53% were female, with a mean STS score of 10% ± 0.1%. Following MVL, there was a reduction in the invasively measured mean trans‐mitral gradient compared to baseline (14 mmHg vs. 6 mmHg; p < 0.05). The primary endpoint was achieved in 8 patients (53%) with no major procedural complications. At follow‐up (median 90 days, IQR 58‐115 days), 14 (93%) patients reported improved symptoms from New York Heart Association (NYHA) Class III–IV to NYHA Class I–II (p < 0.01) with stable echo‐derived mean gradient (7.7 mmHg ± 2 mmHg vs. 8.4 mmHg ± 2.9 mmHg (p = 0.7).ConclusionsIn selected patients with symptomatic inoperable calcific MS, MVL was safe and associated with significant short‐term clinical and hemodynamic improvement. MVL may represent a new compassionate therapy for this challenging cohort. Further studies are needed to determine the long‐term outcomes and help define the role of IVL technology in treating calcific valvular conditions.

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A comparison of cylindrical and Inoue balloon techniques for mitral valvotomy in patients in the United Kingdom.

Cited by 9 publications

References 18 publications

Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

Clinical and haemodynamic profiles of young, middle aged, and elderly patients with mitral stenosis undergoing mitral balloon valvotomy

Percutaneous balloon mitral valvuloplasty with shockwave lithotripsy for the treatment of calcific mitral valve stenosis

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