Percutaneous balloon dilatation of the mitral valve in patients who were unsuitable for surgical treatment.

Abstract

Objective-To assess the effects on haemodynamic function and symptoms of percutaneous balloon dilatation of mitral stenosis in patients unable to undergo surgical treatment because of associated medical/cardiac problems.

Balloon mitral valvuloplasty employing double transseptal puncture

“…The results in our small series are in keeping with those expected of the traditional approach, given the unsuitable nature of the patients and their mitral valve morphology [12,13]. Although it was disappointing that one patient developed significant mitral regurgitation, it seems unlikely that the presence of the pigtail catheter alongside the inflated Inoue balloon could have led to leaflet tear or chordal damage.…”

Percutaneous Approaches to Valvular Disease

“…PMC is the procedure of choice when surgery is contraindicated or very high risk 26 or for patients with favorable characteristics, ie, young patients with favorable anatomy. In this latter population, we have available several randomized studies comparing PMC and surgical commissurotomy.…”

VALVE DISEASE: Balloon valvuloplasty

“…PMC is the procedure of choice when surgery is contraindicated11 or for patients with favourable characteristics—that is, young patients with favourable anatomy. In this latter population several randomised studies comparing PMC and surgical commissurotomy are now available 12.…”

“…The same strategy can also be proposed when the risk of surgery is high—in the elderly11 14 where PMC can be considered as a palliative treatment, in patients with a previous history of surgical commissurotomy15 or aortic valve replacement, and during pregnancy if symptoms persist despite medical treatment 16

Percutaneous mitral commissurotomy (PMC)

PMC has been used in the treatment of severe mitral stenosis for over 10 years

PMC is usually performed after transeptal catheterisation of the left atrium using the Inoue balloon technique

The treatment is effective, with valve area doubling on average following the procedure

The risk with PMC is low when performed by an experienced interventionist team

10 year follow ups have shown good results

Prediction of immediate and mid term results is multifactorial, based on clinical and anatomic variables

Quality of the immediate results is an important predictor of long term outcome

In patients with favourable characteristics, PMC has become the technique of choice, replacing surgical commissurotomy

In other patients a decision to use PMC should be taken on an individual basis, and the percutaneous technique could be considered as complementary to valve replacement

…”