Mitral balloon valvuloplasty by Inoue technique without echocardiographic stand by

ABSTRACT

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