Inoue Balloon Mitral Commissurotomy Research Articles

Interatrial septum puncture in lateral view is the best technique during percutaneous mitral commissurotomy by the Inoue method even in difficult situation

Background There have been no single-center studies that have systematically addressed the acute outcome of Inoue balloon mitral commissurotomy (BMC) performed in a large series of patients. Accordingly, this study sought to examine the impact of operator experience and continuing technical modifications on the success and complication rates of BMC. Methods BMC was performed in 799 patients: 469 patients with pliable mitral valves (group 1) and 330 patients with calcified valves and/or severe subvalvular disease (group 2). Acute complications were examined and compared between groups before and after modifications in BMC techniques. Major modifications included the use of a height-derived balloon sizing method for the selection of an appropriate balloon catheter, a cautionary stepwise dilation technique, and avoidance of traction on the interatrial septum during balloon inflations. Results Technical failures were encountered in 4 (0.5%) patients in our early experience. One patient sustained cardiac perforation and tamponade and was the only case requiring emergency surgery. There were no deaths. Systemic embolic events were observed in 11 (1.4%), all among the first 353 patients before the routine use of pre-BMC transesophageal echocardiography. Severe postprocedure angiographic (≥3+) mitral regurgitation occurred in 4% of patients, 2% in group 1 versus 9% in group 2 (P = .0001). With increased operator experience and technical modifications, this complication was significantly reduced from 5% (7 of 150 patients) to 0% in the last 316 patients in group 1 (P = .0001) and from 11% (26 of 228 patients) to 3% (3 of 101 patients) in group 2 (P = .031). The incidence of significant interatrial shunting (pulmonary-to-systemic flow ratio ≥1.3) was also significantly reduced from 12% to 6% (P = .0034). Conclusion Incremental operator experience and ongoing technical refinements in BMC techniques have resulted in a 100% technical success rate and a significant diminution in complications in patients with a wide spectrum of stenotic mitral valve morphologic features. (Am Heart J 1999;138:114-21.)

Successful Inoue balloon mitral commissurotomy in double-orifice mitral stenosis

We report a rare case of stenotic double-orifice mitral valve of incomplete bridge type in a 40-year-old male. The fibrous bridge tissue between the leaflets was successfully split with a 24-mm Inoue balloon catheter using the stepwise dilation technique. Cathet. Cardiovasc. Intervent. 49:200-203, 2000.

Complications of Inoue balloon mitral commissurotomy: Impact of operator experience and evolving technique

Background There have been no single-center studies that have systematically addressed the acute outcome of Inoue balloon mitral commissurotomy (BMC) performed in a large series of patients. Accordingly, this study sought to examine the impact of operator experience and continuing technical modifications on the success and complication rates of BMC. Methods BMC was performed in 799 patients: 469 patients with pliable mitral valves (group 1) and 330 patients with calcified valves and/or severe subvalvular disease (group 2). Acute complications were examined and compared between groups before and after modifications in BMC techniques. Major modifications included the use of a height-derived balloon sizing method for the selection of an appropriate balloon catheter, a cautionary stepwise dilation technique, and avoidance of traction on the interatrial septum during balloon inflations. Results Technical failures were encountered in 4 (0.5%) patients in our early experience. One patient sustained cardiac perforation and tamponade and was the only case requiring emergency surgery. There were no deaths. Systemic embolic events were observed in 11 (1.4%), all among the first 353 patients before the routine use of pre-BMC transesophageal echocardiography. Severe postprocedure angiographic (≥3+) mitral regurgitation occurred in 4% of patients, 2% in group 1 versus 9% in group 2 ( P = .0001). With increased operator experience and technical modifications, this complication was significantly reduced from 5% (7 of 150 patients) to 0% in the last 316 patients in group 1 ( P = .0001) and from 11% (26 of 228 patients) to 3% (3 of 101 patients) in group 2 ( P = .031). The incidence of significant interatrial shunting (pulmonary-to-systemic flow ratio ≥1.3) was also significantly reduced from 12% to 6% ( P = .0034). Conclusion Incremental operator experience and ongoing technical refinements in BMC techniques have resulted in a 100% technical success rate and a significant diminution in complications in patients with a wide spectrum of stenotic mitral valve morphologic features. (Am Heart J 1999;138:114-21.)

A Prospective Echocardiographic Study of the Effects of Balloon Mitral Commissurotomy on Pre-Existing Mitral Regurgitation in Patients with Mitral Stenosis

Mitral regurgitation which is more than mild in severity is usually regarded as a relative contraindication to balloon mitral commissurotomy (BMC) because it is commonly believed that it may be worsened by the procedure. The aim of this study was to investigate the effects of BMC on pre-existing mitral regurgitation. Transthoracic and biplane transoesophageal echocardiography (TTE, TEE) combined with colour flow mapping (CFM) were performed prospectively on 50 consecutive patients immediately before and within 24 h after Inoue BMC. Before BMC, mitral regurgitation (MR) was diagnosed by TEE and left ventriculography in 36 and 13 patients respectively. Angiographic MR was mild in all 13 cases. The precise origins of MR jets were carefully sought by scanning in multiple TTE and TEE views. The maximal area of colour flow MR jets detected by TEE was measured by planimetry. After BMC mean mitral valve area increased from 1.0 ± 0.3 to 1.7 ± 0.8 cm², p < 0.0001, mean left atrial pressure and volume decreased from 23.7 ± 5.6 mm Hg to 21.6 ± 7.5 ml, p = 0.039, and from 105 ± 56 to 90 ± 46 ml, p = 0.002, respectively. MR jets as assessed by TEE CFM disappeared in 12 patients, in all of whom MR had been undetected by angiography. MR jets remained within 20% of their original sizes in 16 (44%) patients and more than doubled in only 3 patients. However, the latter had only mild angiographic MR after BMC. BMC created new MR jets, distinct from pre-existing ones, in 27 (75%) patients. Their aetiologies were commissural splitting in 24, leaflet tears in 2 and chordal rupture in 1 case. New MR jets were co-existent with old jets in 17 (47%) cases and in 10 (28%) cases old jets were replaced by new jets. The severity of angiographic MR was unchanged in 21 (58%) of the 36 patients; new jets, all originating from one or both commissures, were found in 13 (65%) patients on TEE. Angiographic MR increased by 1 grade in 11 (33%) patients; new jets were detected in 9 patients, 8 from the commissures and 1 due to chordal rupture; in only 1 of the 11 patients did the increase in MR appear to be due to a worsening of a pre-existing jet. Angiographic MR increased by 2 grades in 3 (8%) patients; new jets appeared in all 3, arising from the commissures in 2 and from a leaflet tear in 1 case. One patient with a leaflet tear sustained an increase of 3 grades in angiographic MR. The final degree of angiographic MR was nil in 13, mild in 15, moderate in 6 and severe in 2 patients. Leaflet tears were responsible for both cases of severe MR. BMC does not appear to affect pre-existing mitral regurgitation adversely in almost all patients. It may abolish trivial jets but in most cases it creates new jets alongside the old ones. Leaflet tears are responsible for severe mitral regurgitation after BMC and this is independent of pre-existing regurgitant jets.

Pressure Zone Used and the Occurrence of Mitral Regurgitation in Inoue Balloon Mitral Commissurotomy - A Prospective Study

Pressure Zone Used and the Occurrence of Mitral Regurgitation in Inoue Balloon Mitral Commissurotomy - A Prospective Study

Pressure zone used and the occurrence of mitral regurgitation in inoue balloon mitral commissurotomy

Pressure zone used and the occurrence of mitral regurgitation in inoue balloon mitral commissurotomy

Pressure zone used and the occurrence of mitral regurgitation in Inoue balloon mitral commissurotomy.

Mitral regurgitation (MR) is a known complication of Inoue balloon mitral commissurotomy (BMC) and has been variously ascribed to the presence of severe subvalvular pathology (SVP), preexisting MR, calcification, or oversizing. The pressure zone used--with the low pressure zone (LPZ) the lower half of the spectrum of sizes available out of a single balloon, and the high pressure zone (HPZ) the upper two levels, i.e., within 2 mm of its maximum size--could have a bearing on the occurrence of MR, but has not been studied before. We analysed 251 consecutive patients (mean age 28.6 + 9.7 years), undergoing BMC from October 1993 onwards, with pliable, non-calcific, splittable (bilateral dark zones present) valves with not more than trivial MR (1 + in grades of 1-4). Balloon sizing was done with standard formula using height with stepwise dilatation starting 2 mm below the reference size. Thirty-two patients additionally had severe SVP. Patients were divided into two groups, HPZ-BMC and LPZ-BMC, depending upon the final balloon size needed for a successful result. Incidence of MR (2+ or more) was significantly lower in the LPZ BMC (18%) vs. HPZ BMC (32.2%) (P < 0.05). Moderate to severe MR (3+/4+) was also less in LPZ BMC (2.8%) vs. HPZ BMC (8.2%) (P < 0.05). Amongst patients with severe SVP, 3/15 (20%) developed MR in the LPZ-BMC group (all mild only) as against 8/17 (42%) (P < 0.05) in the HPZ-BMC group with half of them having moderate to severe MR. In 54 patients where the reference size had to be exceeded, no patient (0/8) developed MR as long as the higher size was in the LPZ of the particular balloon used as compared to 17/46 (36.9%) who developed MR when the size used fell in the HPZ. We conclude that the pressure zone used has a strong bearing on the occurrence of MR in Inoue BMC and that a low-pressure strategy could avoid MR.

Impact of Operator Experience and Evolving Technique on Complications of Inoue-Balloon Mitral Commissurotomy

Impact of Operator Experience and Evolving Technique on Complications of Inoue-Balloon Mitral Commissurotomy

Long-term (36-63 month) clinical and echocardiographic follow-up after Inoue balloon mitral commissurotomy.

Although Inoue balloon mitral commissurotomy (BMC) offers excellent short-term results, there remains a paucity of data on its long-term (> or =3 yr) outcome. We therefore analyzed the outcome of 68 consecutive patients who had regular long-term clinical and serial echocardiographic follow-up of > or =3 yr after successful BMC. The procedure provided significant improvements in transmitral valve gradient (13+/-6 mmHg before to 5+/-2 mmHg after BMC, P = 0.0001), left atrial pressure (21+/-6 mmHg before to 14+/-5 mmHg after BMC, P = 0.0001), and mitral valve area (0.8+/-0.2 cm2 before to 1.7+/-0.4 cm2 after BMC, P = 0.0001) without incurring > grade 2+ angiographic mitral regurgitation. At a mean follow-up of 44+/-9 mos (range, 36-63 mo), functional benefits were maintained in 91% of patients. Serial echocardiographic evaluations performed in 97% of patients revealed a restenosis rate of 15% (defined as a loss of >50% initial gain in valve area or a valve area of <1.5 cm2). No strokes or deaths were encountered. Of the 15 clinical, echocardiographic, and procedural variables analyzed in a multivariate model, only the presence of chronic atrial fibrillation was an independent correlate of restenosis (P < 0.05). It was clearly more common in patients with than those without restenosis (100% with vs. 57%, respectively, P = 0.009). In conclusion, our study shows that BMC confers maintained long-term functional benefits and a low anatomic restenosis rate 23 yr after BMC.

Pressure zone used and the occurrence of mitral regurgitation in inoue balloon mitral commissurotomy — a prospective study

Pressure zone used and the occurrence of mitral regurgitation in inoue balloon mitral commissurotomy — a prospective study

Impact of operator experience and evolving technique on complications of Inoue-balloon mitral commissurotomy

Impact of operator experience and evolving technique on complications of Inoue-balloon mitral commissurotomy

Immediate and Long-Term Results of Percutaneous Inoue Balloon Mitral Commissurotomy With Use of a Simple Height-Derived Derived Balloon Sizing Method for the Stepwise Dilation Technique

To assess the short- and long-term efficacy of Inoue balloon percutaneous transvenous mitral commissurotomy (PTMC) with use of our simple balloon sizing method based on patient height. Data from 105 consecutive patients with symptomatic mitral stenosis who underwent 107 PTMC procedures between October 1991 and April 1995 at our hospital were analyzed. All PTMC procedures were successfully completed with no instances of cardiac perforation, systemic embolism, severe mitral regurgitation (grade 3 or more angiographically), or death. The mean mitral valve area increased from 0.8 +/- 0.2 cm2 to 1.7 +/- 0.4 cm2 (P = 0.0001), as assessed echocardiographically. Optimal results -- defined as an improvement in valve area of 50% or more or a final valve area of 1.5 cm2 or more without significant mitral regurgitation (an increase in mitral regurgitation of two or more grades or a final regurgitation of grade 3 or more) -- were obtained in 96% of patients. At a mean follow-up interval of 20 months, symptomatic benefit was maintained in 97% of patients. Echocardiographic evidence of restenosis (loss of more than 50% initial gain in valve area, a valve area of less than 1.5 cm2, or both) was noted in 9.8%. Inoue balloon PTMC with use of our simple balloon sizing method yielded excellent short- and long-term results in terms of mitral valve enlargement and sustained symptomatic benefit without the creation of severe mitral regurgitation.

Pitfalls and tips in inoue balloon mitral commissurotomy.

Balloon mitral commissurotomy is a safe and effective alternative therapeutic modality in selected patients with significant rheumatic mitral stenosis. Since its introduction in 1984, Inoue balloon mitral commissurotomy has gained wider acceptance over other balloon valvuloplasty techniques because it is technically less demanding and associated with fewer complications. Nevertheless, certain pitfalls which may make the procedure more difficult or create complications are sometimes encountered. In this article, we offer tips to facilitate a safe and expeditious execution of Inoue balloon mitral commissurotomy based on our experience with over 1,000 procedures.

Safety of Inoue balloon mitral commissurotomy in patients with left atrial appendage thrombi

Safety of Inoue balloon mitral commissurotomy in patients with left atrial appendage thrombi

Selection of catheter size for Inoue balloon mitral commissurotomy

Catheterization and Cardiovascular DiagnosisVolume 33, Issue 2 p. 130-131 Editorial Comment Selection of catheter size for Inoue balloon mitral commissurotomy Ted Feldman MD, FSCAI, Ted Feldman MD, FSCAI University of Chicago Hospital, Chicago, IllinoisSearch for more papers by this author Ted Feldman MD, FSCAI, Ted Feldman MD, FSCAI University of Chicago Hospital, Chicago, IllinoisSearch for more papers by this author First published: October 1994 https://doi.org/10.1002/ccd.1810330208Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue2October 1994Pages 130-131 SCAI Member Sign in RelatedInformation