Percutaneous transluminal mitral commissurotomy--experience with inoue balloon and over the wire technique.

OBJECTIVE: To compare the immediate and long-term results, safety and complication profile of inoue balloon technique (IBT) and over the wire technique (OWT) in the treatment of rheumatic mitral stenosis. METHODS: We have compared the IBT in 104 patients and OWT in 40 patients. Preprocedural, immediate post-procedure and follow-up echocardiograms of both groups of patients were done. RESULTS: There was no statistically significant difference in the success rates between IBT and OWT (97% vs. 95%; p > 0.05), nor was there a difference in reduction in mean left atrial pressure, mean pulmonary artery pressure, the occurrence of significant mitral regurgitation, or mortality (p > 0.05). The cost per procedure was cheaper with OWT but the occurrence of sustained ventricular tachycardia (VT) during the procedure was more common with OWT. OWT uses a stiff guidewire for positioning the balloon across the mitral valve, which is not done in IBT, hence there is the possibility of left ventricular perforation--which in fact occurred in one of our patients. During a mean follow up period of 12.9 months for IBT and 13.5 months for OWT, there was no significant restenosis in both the groups. The advantage of the OWT was the cheaper cost of the balloon and comparable results with IBT despite longer fluoroscopy and procedural times and the increased incidence of arrhythmias during the procedure. CONCLUSION: In a third world country like ours where escalating cost may be a deterrent in performing interventions, the OWT is a comparable alternative to IBT.

Valvuloplasty balloon detaching from the stem of a catheter.

A 12-year-old boy underwent pulmonary balloon valvotomy for isolated critical pulmonary stenosis. Following valvotomy, blood was found to be drawn into the syringe during deflation of the balloon, so a provisional diagnosis of a burst balloon was made. However, when the balloon catheter was withdrawn, the balloon got detached from the stem of the catheter at the level of the right atrium and was retained over the exchange guidewire. The balloon, when retrieved with a snare, was found to be intact. The balloon may have been partially detached at the junction of the proximal end of the balloon and the catheter; hence, blood was drawn from the catheter during deflation. In our institution balloons are reused following sterilization with ethylene oxide gas. We conclude that any balloon presumed to have burst inside the heart must be removed with great caution. In a third world country like India, where cost is an important factor, balloons can be reused, but with caution, keeping in mind complications such as in this case.