Mitral valvuloplasty by inoue balloon under transthoracic echocardiographic guidance.
BACKGROUND
Mitral valvuloplasty traditionally performed under fluoroscopic guidance has emerged as an effective nonsurgical technique for the treatment of symptomatic patients with mitral stenosis. We undertook a study to evaluate the feasibility of performing valvuloplasty by the Inoue balloon solely under transthoracic echocardiographic (TTE) guidance with the backup of transesophaeal echocardiography (TEE) and fluoroscopy.


METHODS
Between September 2003 and July 2004, mitral valvuloplasty using the Inoue balloon was performed solely under TTE guidance in the catheterization laboratory with backup of fluoroscopy and TEE in 75 patients (52 female patients, including 18 who were pregnant, and 23 male patients) with symptomatic mitral stenosis (New York Heart Association class II-IV) with satisfactory TTE window and valve morphology suitable for valvuloplasty.


RESULTS
The procedure was technically successful (no requirement of TEE or fluoroscopy) in 68 patients (89%). TEE was required for septal puncture in 3 patients whereas fluoroscopic assistance was required to complete the procedure in 4 patients. Procedural success after valvuloplasty (doubling of mitral valve area or mean gradient across mitral valve < 5 mm Hg in absence of complications like severe mitral regurgitation or tamponade) was achieved in 70 patients. There was an increase in mean mitral valve area as assessed echocardiographically from 0.84 +/- 0.16 cm2 to 1.7 +/- 0.27 cm2 with decrease in mean diastolic gradient from 27.2 +/- 8.4 mm Hg (18-36 mm Hg) to 5.2 +/- 4.1 mm Hg (3-14 mm Hg). The mean procedure time was 27.2 +/- 8.4 minutes (15-45 minutes). Mild mitral regurgitation appeared or increased in severity to moderate degree as assessed by color Doppler during the procedure in 11 patients (14.6%) but no patient developed severe mitral regurgitation. No patient had cardiac tamponade as puncture of the septum under TTE guidance prevents inadvertent puncture of the aorta, coronary sinus, inferior vena cava, and right atrial and left atrial wall that sometimes occurs during septal puncture under fluoroscopic guidance.


CONCLUSIONS
Balloon mitral valvuloplasty under sole TTE guidance is safe and feasible in experienced hands.
Trehan
Vijay
V
Department of Cardiology, G B Pant Hospital, New Delhi, India.
Mukhopadhyay
Saibal
S
Nigam
Arima
A
Yusuf
Jamal
J
Mehta
Vimal
V
Gupta
Mohit Dayal
MD
Girish
Meenahalli Palleda
MP
Tyagi
Sanjay
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002648:Child; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000453:epidemiology* / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome