ADVANTAGE OF INOUE BALLOON CATHETER IN MITRAL BALLOON VALVOTOMY - EXPERIENCE WITH 220 CONSECUTIVE PATIENTS

Percutaneous mitral balloon valvotomy (PMV) using the Inoue balloon ca theter was attempted in 220 consecutive patients with severe symptomat ic mitral stenosis. Their age range was 10-63 mean 30 +/- 10 years; 16 1 patients were females and 59 were males; 29 patients were in atrial fibrillation. Eleven patients were pregnant; 14 patients underwent pre vious surgical commissurotomy. The procedure was technically successfu lly performed in 215 (97.7%) patients. The mean fluoroscopy time was 1 5.5 +/- 6.4 min and mean procedure time was 109 +/- 79 min. Optimal re sults (group I) was achieved in 207 patients who have mitral score of 7 +/- 1. PMV resulted in decrease in left atrial pressure from 23 +/- 5 to 14 +/- 4 mm Hg (P < 0.001), the mean mitral valve gradient (MVG) decreased from 15 +/- 4 to 6 +/- 3 mm Hg (P < 0.001). The mitral valve area (MVA) by catheter increased from 0.7 +/- 0.2 to 1.7 +/- 0.5 cm(2 ) (P < 0.001) and MVA as determined by echocardiography (2DE) increase d from 0.8 +/- 0.1 to 1.9 +/- 0.3 cm(2) (P < 0.001). The results were suboptimal in eight patients who have a mitral score of 10 +/- 1 (grou p II) MVA by catheter increased from 0.7 +/- 0.2 to 1 +/- 0.1 cm(2) an d Doppler MVA increased from 0.8 +/- 0.1 to 1.3 +/- 0.1 cm(2). There w ere no deaths or thromboembolism. Two patients developed cardiac tampo nade; mild mitral regurgitation (MR) developed in 24 patients (11%) an d increased by one grade in another 22 patients (10%). Severe MR was e ncountered in three patients (1.4%). A small ASD (QP/QS less than or e qual to 1.3) was detected by oximetry in 5% of patients and by color-f low mapping in 26% of patients. One hundred fifty-eight patients from group I were followed up, for a mean of 32 +/- 12 months; MVA remained at 1.7 +/- 0.4 cm(2). Seven patients developed mitral restenosis in g roup I, and 5 out of 8 patients developed restenosis in group II. We c onclude that the hemodynamic results are good and comparable with thos e reported with double balloon technique. However, the Inoue balloon h as several advantages over the double balloon technique: (1) low incid ence of mitral regurgitation and ASDs; (2) shorter procedure and fluor oscopy time; and (3) low complication rates and the valve anatomy affe cts the immediate and late outcome of mitral balloon valvotomy. (C) 19 96 Wiley-Liss, Inc.