Mitral balloon valvuloplasty by inoue technique A new emerging indications

Mitral balloon Valvuloplasty [MBV] by Inoue technique [1] was performed in 164 patients [MS]. 64patients were male and 100 patients were female. The age range was 9-62 years [mean28]. All patients were subjected to echocardiographic and Doppler examinations before and one day after the procedure. The first57 patients were subjected to exercise tolerance test [ETT] few days before and few days after the procedure. An echocardiographic score was measured regarding valve thickening, leaflet mobility, degree of calcification and the severity of involvement of the subvalvular apparatus [2], patients with> grade 2/4 mitral regurgitation [MR] and fresh mobile left atrial thrombus [LAT] were excluded. Patients with commissural calcifications, resolved or organized thrombus were also subjected to [MBV]. No echocardiographic stand by was needed during the procedure. [3] Mitral valve area [MVA] increased from 0.9 +/- 0.2 cm° to 1.9 +/- 0.45 cm° [P<.001]. Mitral gradient [MG] decreased from 20.85 +/- 8.4mmHg to 11.05 +/- 5.4 mmHg [P<.0001]. [ETT] increased from 5.6 +/- 1.3 to 11.75 +/- 1.5 minute [P<.001]. Complications included severe [MR] in 4 patients [2.5%],cardial tamponade in 1 patient [0.6%],bacterial endocarditis in 1 patient [0.6%]. In the first 57 patients mild left to right shunt measured by green dye dilution technique has occurred in 40% of patients, no patient needed surgery for the shunt. In conclusion, [MBV] by Inoue balloon is a safe and good alternative to surgical commissurotomy and a new emerging indications will be discussed in this study

Mitral balloon valvuloplasty by Inoue technique without echocardiographic stand by

Mitral balloon valvuloplasty [MBV] by Inoue technique was performed in 85 patients with symptomatic rheumatic mitral stenosis [MS]. Twenty-eight patients were male and 57 patients were female. The age range was nine to 59 years [mean 28]. All patients were subjected to echocardiographic and Doppler examinations before and one day after the procedure. The first 57 patients were subjected to exercise tolerance tests [ETT] a few days before and a few days after the procedure. An echocardiographic score was measured regarding valve thickening, leaflet mobility, degree of calcification and the severity of involvement of subvalvular apparatus. The mitral valve area [MVA] increased from 0.9 +/- 0.2 cm[2] to 1.9 +/- 0.45 cm[2], [P<0.0001]. The mitral gradient [MG] decreased from 20 +/- 5.8 mm/Hg to 5.05 +/- 3.2 mm/Hg [P<0.0001]. Mean left atrial pressure [LAP] dropped from 25.85 +/- 8.4 mm/Hg to 11.05 +/- 5.4 mm/Hg [P<0.0001]. Exercise tolerance test [ETT] increased from 5.59 +/- 1.3 to 11.75 +/- 1.48 min.[P<0.0001]. Complications included severe mitral regurgitation [MR] in two patients [2.3%]. In the first 57 patients, mild left-to-right shunt measured by green dye dilution technique had occurred in 40% of patients. In conclusion, MBV by Inoue balloon is a good alternative to surgical commissurotomy and echocardiographic standby is very helpful when it is available. However, MBV can be safely performed if echocardiography is inaccessible

Balloon dilatation for discrete subaortic membranous stenosis Immediate and short term results

Percutaneous balloon dilatation [PBD] for discrete subaortic stenosis [DSS] has been attempted in 10 patients. Mean age 10 year [range 6-20], 4 patients were male and 6 were females. The balloon diameter used ranged from 15-23 mm. 7 patients had thin membrane [m] [group 1], and 3 patients had thick fibromuscular ring [TFR] [group 2]. In group 1 the peak to peak hemodynamic gradient [PPHG] decreased From 75 +/- 21 mmHg to 30 +/- 23 mmHg, and the left ventricular systolic pressure [LVSP] has slightly decreased from 171.8 +/- 80.5 mmHg to 126.3 +/- 21.5 mmHg. In group 2 the [PPHG] decreased slightly from 75.5 +/- 26.3 to 63.5 +/- 18.4 mmHg and the [LVSP] has slightly decreased from 180.5 +/- 32.5 mmHg to 156 +/- 9.3 mmHg. Two patients developed grade I aortic regurgitation, the other 8 patients with pre existent grade one aortic regurgitation, showed no aggravation. One patient developed thrombosis of the right femoral artery, successfully treated by thrombectomy. A mean echocardiographic follow up after 6 months showed stabilization of the post dilatation gradient in group 1. In conclusion, percutaneous balloon dilatation for discrete subaortic stenosis of membraneous etiology offers a good immediate and short term result and constitutes an excellent alternative palliative treatment to surgery, while surgery is indicated for patients with thick firbomuscular ring