Influence of intraballoon pressure on development of severe mitral regurgitation after percutaneous transvenous mitral commissurotomy

Abstract

To evaluate the influence of intra-balloon pressure on the development of severe mitral regurgitation (> or = grade 3+), we measured intraballoon pressure during percutaneous transvenous mitral commissurotomy (PTMC) in 62 patients using the Inoue balloon catheter. The peak intraballoon pressure was 2.29 +/- 0.55 kg/cm2. Severe mitral regurgitation as a result of leaflet tear occurred in 7 patients (11%). Patients were divided into two groups those with (n = 7) and those without (n = 55) severe mitral regurgitation. Intraballoon pressure had been significantly higher in those with vs. those without severe mitral regurgitation (2.76 +/- 0.31 kg/cm2 vs. 2.23 +/- 0.55 kg/cm2, P < 0.01). Multiple logistic regression analysis revealed that the occurrence of severe mitral regurgitation was related to only the peak intraballoon pressure. These data suggest that a high intraballoon pressure is a risk factor for severe mitral regurgitation as a result of leaflet tear.

Pressure zone used and the occurrence of mitral regurgitation in inoue balloon mitral commissurotomy

“…The appearence of a new or increase in preexisting MR is not uncommon, varying from 30-50% [12,13]. Clinically significant MR, however, is quite uncommon (4-15%) [4,17,23,24, 29] in 1994 first showed the significance of intraballoon pressure in the occurrence of MR in a small group of patients when they found higher on-line intraballoon pressures in patients who developed MR as compared to those who did not. Of a total of 62 patients, 7 who developed severe MR had a peak intraballoon pressure of 2.76 Ϯ 0.30 mm Hg/cm 2 vs. 2.23 Ϯ 0.55 mm Hg/cm 2 .…”

“…Intraballoon pressure was shown to have a bearing on the occurrence of MR in the pioneering study by Yamabe et al [29] in which they detected higher on-line intraballoon pressures in patients who developed severe mitral regurgitation following Inoue BMC. Also, intraballoon pressures in the Inoue balloon (second generation) transist suddenly from a ''low-pressure zone'' to a ''highpressure zone'' as the balloon is inflated to within 2 mm of its nominal size [17] (Fig.…”

The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status

“…As the compliance curve of the balloon leads to an exponential rise in radial force in the final millimeter of inflation for any given balloon size (e.g., 27-28 mm in a 28 mm balloon), some operators avoid inflating in the final millimeter of a balloon’s range to avoid additional risk of tearing the leaflets or subvalvular apparatus. 38 Generic versions of the balloon, with a single rather than dual inflation ports, are used in some parts of the world, albeit with a higher failure rate and risk profile in the experience of this author.

Figure 8 Balloon mitral valvuloplasty in a 32-year-old female with rheumatic mitral stenosis.

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