Preventive strategies to fight complications during percutaneous multitrack balloon valvotomy "refining the technique".

BACKGROUND: Percutaneous mitral valvuloplasty (PMV) is still the treatment of choice in selected cases of mitral stenosis (MS). Multitrack balloon (MTB) catheter is one of the techniques used for PMV with optimal results. We describe a novel refinement of appropriate balloon sizing and wire placement to reduce mitral regurgitation (MR) and Left ventricular (LV) apical perforation, respectively. METHODS: Ninety four consecutive patients with moderate to severe rheumatic mitral stenosis (MS) were selected for PMV with MTB catheter. Balloon sizing was done by effective balloon dilatation area (EBDA), using standard geometric formula. 0.35" PMV wire was placed in aortic arch /ascending aorta (AA) to avoid LV apical perforation. RESULTS: Mild MR was present in 28(29.8%). Post-procedure MR was present in 50(53.2%). Out of 50 MR cases 44(88%) had mild and 6(12.0%) had moderate MR. No patient had severe MR. With placement of wire in AA and arch of aorta none of the patients developed complication of LV apical perforation. CONCLUSION: EDBA as balloon sizing for multitrack system can be used to reduce severity of mitral regurgitation. Placement of PMV guide wire in Aortic arch/AA ascending aorta can eliminate/substantially reduce dreadful complication of LV perforation.

Comparison of Inoue balloon, metallic commissurotome and multi-track double-balloon valvuloplasty in the treatment of rheumatic mitral stenosis.

UNLABELLED: 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. CONCLUSION: In conclusion, percutaneous mitral valvuloplasty is an effective procedure for MS with any of the three above techniques.

Short- and intermediate-term follow-up results of percutaneous transluminal balloon valvuloplasty in adolescents and young adults with congenital pulmonary valve stenosis.

Percutaneous pulmonary balloon valvuloplasty (PBV) is a well-established treatment alternative to surgery in many cardiology centers. We described our experience with PBV in 25 adolescent and young adult patients with isolated pulmonary valve stenosis (PVS). Among 20 successful PBVs, there was a significant immediate decrease in right ventricular systolic pressure from 116.9 32.4 mmHg to 60.5 18.7 mmHg (p < 0.0001) and a decrease in transpulmonary valve pressure gradient from 93.5 32.8 mmHg to 33.5 9.7 mmHg (p < 0.0001) was noted. The follow-up period was 1-5 years (mean = 3.2 1.2 years), during which patients were periodically assessed by Doppler echocardiogram. During follow-up, the transpulmonary valve pressure gradient further decreased from 33.5 9.7 mmHg to 18.6 3.4 mmHg (p < 0.0001) mainly due to regression of infundibular hypertrophy. Thus, the study showed excellent short-term and intermediate-term results of PBV.