title: Balloon mitral valvotomy: comparison between antegrade Inoue and retrograde non-transseptal techniques.
abstract: OBJECTIVE
  The results of percutaneous mitral valvotomy performed by the antegrade transseptal method using the Inoue balloon (n = 1000; group 1) and by the retrograde non-transseptal technique using a polyethylene balloon (n = 100; group 2) were compared in a retrospective, non-randomized study.
  
  
  RESULTS
  Both the groups were similar with respect to baseline characteristics. The success rate was 95% in group 1 and 93% in group 2. There was a significant increase in mitral valve area estimated by Gorlin's equation (Group 1: from 0.8 +/- 0.5 to 2.1 +/- 0.8 cm2; Group 2: from 0.8 +/- 0.3 to 1.9 +/- 0.8 cm2, both P < 0.001) and by Doppler echocardiography using the pressure half-time method (Group 1: from 0.9 +/- 0.4 to 2.2 +/- 0.6 cm2; Group 2: from 0.9 +/- 0.3 to 2.0 +/- 0.7 cm2, both P < 0.001). However, the calculated immediate post-valvotomy mitral valve area was larger with the Inoue technique (2.1 +/- 0.8 vs 1.9 +/- 0.8 cm2; (P < 0.02). Results were considered optimal when the mitral valve area increased to > or = 1.5 cm2, the percentage increase was > or = 50, and mitral regurgitation was < or = 2/4. Out of the total successful procedures, optimal results were obtained in 95% patients in Group 1 and 94% in Group 2. Incidence of significant mitral regurgitation (> or = grade 3/4) was similar in two groups (Group 1: 4% vs Group 2: 5%, P = ns). A significant left to right atrial shunt (Qp/Qs > or = 1.5:1) in 2.5% and tamponade in 2% of cases occurred exclusively with the Inoue technique, while conduction disturbances, such as transient (< 24 h) left bundle branch block (28%) and complete heart block (2%) were noted with the retrograde technique (Group 2). Local complications were significantly higher in Group 2 (3% vs 0.5%, P < 0.01). The procedure time with the Inoue technique was shorter than with the retrograde (Group 1: 15 +/- 8, range 10 to 35 min; Group 2: 22 +/- 14, range 15 to 45 min, P = 0.05). Echocardiographic follow-up at 1 year showed no significant difference in mitral valve area between the two groups (Group 1 (n = 300): 1.8 +/- 0.8 vs Group 2 (n = 60): 1.9 +/- 0.9 cm2; P = 0.3).
  
  
  CONCLUSIONS
  Balloon mitral valvotomy using the Inoue balloon and the retrograde non-transseptal technique results in significant immediate haemodynamic and symptomatic improvement. The Inoue technique achieved a larger immediate post-valvotomy mitral valve area, but the difference was not apparent at 1 year follow-up. Incidence of significant mitral regurgitation was similar with both the techniques; however, local complications occurred more frequently with the retrograde technique. Both techniques may complement each other in technically difficult cases.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: V K
authors.initials: VK
authors.lastname: Bahl
authors.forename: S
authors.initials: S
authors.lastname: Chandra
authors.forename: D K
authors.initials: DK
authors.lastname: Jhamb
authors.forename: K C
authors.initials: KC
authors.lastname: Goswami
authors.forename: R
authors.initials: R
authors.lastname: Juneja
authors.forename: D
authors.initials: D
authors.lastname: Thatai
authors.forename: K K
authors.initials: KK
authors.lastname: Talwar
authors.forename: H S
authors.initials: HS
authors.lastname: Wasir
mesh_terms: D000328:Adult; D021721:Balloon Occlusion; D002404:Catheterization / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve; D008946:Mitral Valve Stenosis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome