Percutaneous mitral valvuloplasty: Retrograde, transarterial double‐balloon technique utilizing the transseptal approach

Abstract

Between February 1985 and May 1987, 72 patients with mitral stenosis (MS) underwent percutaneous transluminal mitral valvuloplasty (PTMV). The retrograde transarterial double-balloon technique was used on 54/72 patients (75%); 16 males, 38 females; mean age: 39 +/- 11 years. Transseptal catheterization was used to place two 0.035", 350-cm exchange wires into the ascending aorta in order to be snared, retrieved, and exteriorized, each through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for PTMV. The transmitral mean gradient fell [18 +/- 4 to 9 +/- 5 mmHg (P less than 0.001)]; the cardiac output increased [5.1 +/- 0.8 6.1 +/- 0.8 L/min (P less than 0.001)]; the hemodynamically calculated valve area increased [1.2 +/- 0.2 to 2.3 +/- 0.6 cm2 (P less than 0.001)]; and the short axis two-dimensional echocardiographic valve area increased [1.1 +/- 0.3 to 2.2 +/- 0.7 (P less than 0.001)]. PTMV was unsuccessful in two patients (4%), due to the inability to maintain the inflated balloons in the mitral position. Significant complications were encountered in two patients: two strokes (3.7%) and one mortality from the stroke (1.4%). Significant mitral regurgitation occurred in two patients (3.7%); no post-PTMV hemodynamically significant atrial septal defects were detected. Follow-up (mean time: 11 +/- 6 months) of 43 patients showed a persistent improvement in echocardiographic findings in 27 (63%) and hemodynamically measured mitral valve area in the 16 patients in which cardiac catheterization was repeated. The retrograde, transarterial double-balloon technique can successfully accomplish PTMV with good results and an acceptable low morbidity and mortality.

Percutaneous transarterial balloon dilatation of the mitral valve: five year experience.

“…French retrieval catheter7 was advanced through a sheath from the left femoral artery to the aortic root where its wire loop was opened. A 7 French floating Swan-Ganz catheter (Vygon), which permits a 0 035 inch wire to pass through its central lumen, was advanced through the Mullins sheath into the left atrium. The Swan-Ganz floating catheter Babic, Grujicic, Popovic, Djurisic, Pejcic, Vucinic was inflated with carbon dioxide and advanced through the left ventricle into the aortic root across the wire loop of the retrieval catheter.…”

Percutaneous balloon mitral valvuloplasty and its different approaches: A new perspective

“…Initially, only one balloon was used. The new paper by Babic et al [3] introducing their double-balloon technique is a very important contribution in performing balloon mitral valvuloplasty. We have now been using the double-balloon technique by the transarterial approach introducing both exchange wires and balloon catheters from the same puncture site in the right femoral artery (paper submitted).…”

Editorial comment: How to avoid cardiac tamponade during percutaneous balloon mitral valvuloplasty

“…Therefore, the patient never runs the risk of left ventricular perforation by the Inoue balloon catheter. On the other hand, the use of a double and longer balloon catheter in a patient with a small left ventricle predisposes to left ventricular perforation, especially if the operator was unable to maintain the curled guidewire in the left ventricular apex [9][10][11]. …”

“…Because no left ventricular perforation has ever been reported with the Inoue balloon catheter in a series of 4,832 patients from China [9], Inoue balloon catheter technique should be the procedure of choice for percutaneous balloon mitral valvuloplasty. Besides, it has so many other uses [16].…”