Comparison of Inoue balloon, metallic commissurotome and multi-track double-balloon valvuloplasty in the treatment of rheumatic mitral stenosis.
BACKGROUND Percutaneous mitral valvuloplasty (PMV) is a well known non-surgical technique for treating patients with rheumatic mitral stenosis (MS). There are very few studies that have compared the 3 techniques together for their safety and efficacy.


METHODS
To compare the three different techniques for percutaneous mitral valvuloplasty (PMV) using Inoue balloon (IB), metallic commissurotome (PMMC), or multi-track double balloon (MTDB) in patients with MS.


RESULTS
A total of 486 patients were subjected to PMV using any of the 3 techniques, IB, PMMC or MTDB. The overall success rate was 97.3% (n = 473); 95.7% for IB, 97.6% for PMMC, and 98.3% for MTDB. Overall, the transmitral gradient decreased from 20.7 +/- 7.2 mmHg to 6.5 +/- 3.7 mmHg (p < 0.001) and mitral valve area (MVA) increased from 0.87 +/- 0.2 cm(2) to 1.9 +/- 0.4 cm(2) (p < 0.001). Left atrial pressure decreased from 29.3 +/- 8.4 mmHg to 16.1 +/- 11.5 mmHg (p < 0.001) and pulmonary arterial pressure decreased from 76.9 +/- 41.8 mmHg to 45.2 +/- 17.6 mmHg (p < 0.001). Thirteen patients (2.7%) required mitral valve replacement (MVR) for severe mitral regurgitation (MR) while one patient (0.2%) developed cardiac tamponade requiring urgent pericardiocentesis followed by surgical repair of the tear and open mitral valvotomy. There was no statistical difference among the 3 techniques used.


CONCLUSIONS
In conclusion, percutaneous mitral valvuloplasty is an effective procedure for MS with any of the three above techniques.
Sharieff
Saleem
S
Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada. saleem_sharieff@hotmail.com
Aamir
Kanwal
K
Sharieff
Waseem
W
Tasneem
Habiba
H
Masood
Tariq
T
Saghir
Tahir
T
Shah-e-Zaman
Khan
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery / Q000628:therapy*; D008946:Mitral Valve Stenosis / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000601:surgery / Q000628:therapy*