Concurrent antegrade transseptal inoue‐balloon mitral and aortic valvuloplasty

Abstract

Concurrent antegrade, transseptal Inoue-balloon aortic and mitral valvuloplasty, is feasible and safe, and provides excellent immediate results as one-stage procedure. The study results also suggest that balloon aortic valvuloplasty can be more durable in younger patients with rheumatic AS than in elderly patients with degenerative, AS. However, the modified aortic valvuloplasty technique can be utilized only as bridging procedure to aortic valve replacement or recently developed transcatheter aortic-valve implantation in unstable hemodynamic status, and as a palliative procedure before noncardiac surgery.

Transvenous Transseptal Concurrent Inoue Balloon Mitral and Aortic Valvuloplasty in an Octogenarian With Severe Aortic and Mitral Stenosis

“…2H). 2 The transaortic valve mean pressure gradient decreased from 35 to 10 mm Hg, and the transmitral valve mean pressure gradient decreased from 15 to 5 mm Hg after intervention. Pulmonary edema resolved in the following days, and the patient was discharged uneventfully.…”

“…We have modification of the procedure in adopting an ICE guidance in transseptal puncture, which could help visualize the atrial septum clearly and improve its safety. 5 Other than this modification, we closely followed the protocol proposed by Abdou et al, 2 with BAV first strategy, and snaring the transvenous/transseptal wire and externalizing it outside the left femoral artery to achieve better wire support and stability.…”

“…1 The standard management should be combined surgical aortic and mitral valve replacement. 1 Other options include transcatheter aortic valve implantation (TAVI) plus percutaneous transseptal Inoue (Toray, Tokyo, Japan) balloon mitral valvuloplasty (BMV), concurrent transvenous transseptal Inoue balloon aortic valvuloplasty (BAV) and BMV, 2 or transvenous transseptal BMV and retrograde transarterial BAV.…”

“…The patient had pulmonary edema and persistent heart failure signs, so we decided to perform transvenous transseptal concurrent BAV and BMV on December 30, 2013. We followed the protocol proposed by Abdou et al, 2 except that we modified the procedure using ICE to guide the transseptal puncture ( Fig. 1).…”

“…2G). 2 Afterward, the BMV was done with the same Inoue balloon inflated up to 24 mm at the mitral annulus level (Fig. 2H).…”