title: Concurrent antegrade transseptal Inoue-balloon mitral and aortic valvuloplasty.
abstract: BACKGROUND
  The Inoue balloon has been in use for many years for mitral valvuloplasty. Aortic valvuloplasty using the Inoue balloon via transseptal approach was developed in the hope of providing better results with less potential vascular access complications.
  
  
  RESULTS
  In this study, we present our experience in percutaneous valvuloplasty using the Inoue balloon in 14 patients with combined rheumatic mitral and aortic stenosis (AS) in a single stage procedure via antegrade transseptal approach. The study group was characterized by relatively young age (mean 37.5 ± 9.6 years). Aortic followed by mitral valvuloplasty via antegrade approach resulted in a fall of transaortic peak pressure gradient (PG) from 59.1 ± 11.2 mm Hg to 25.3 ± 12.5 mm Hg (P = 0.012) and mean from 49.0 ± 10.9 mm Hg to 16.6 ± 9.8 mm Hg (P = 0.043). Aortic valve areas increased significantly from 0.70 ± 0.25 cm(2) to 1.41 ± 0.48 cm(2) (P = 0.042). Mean transmitral PG decreased from 14.9 ± 2.1 mm Hg to 5.3 ± 1.5 with increase of mitral valve areas from 1.08 ± 0.45 to 1.92 ± 0.51 cm(2). The procedures were well tolerated without development of significant valvular regurgitation or thromboembolism. During follow-up, 2 patients died due to lung cancer and sudden death at months 48 and 100. Five patients received delayed surgery after mean duration of 73.4 ± 39.7 months.
  
  
  CONCLUSIONS
  Concurrent antegrade, transseptal Inoue-balloon aortic and mitral valvuloplasty, is feasible and safe, and provides excellent immediate results as one-stage procedure. The study results also suggest that balloon aortic valvuloplasty can be more durable in younger patients with rheumatic AS than in elderly patients with degenerative, AS. However, the modified aortic valvuloplasty technique can be utilized only as bridging procedure to aortic valve replacement or recently developed transcatheter aortic-valve implantation in unstable hemodynamic status, and as a palliative procedure before noncardiac surgery.
authors.affiliation: Division of cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Cardiology Department, National Heart Institute, Cairo, Egypt.
authors.forename: Sayed M
authors.initials: SM
authors.lastname: Abdou
authors.forename: Yung-Lung
authors.initials: YL
authors.lastname: Chen
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Kean-Wah
authors.initials: KW
authors.lastname: Lau
authors.forename: Jui-Sung
authors.initials: JS
authors.lastname: Hung
mesh_terms: D000328:Adult; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization; D018450:Disease Progression; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult