COMPLICATIONS OF PERCUTANEOUS MITRAL VALV ULOPLASTY - COMPARISON BETWEEN THE DOUBLE-BALLOON AND INOUE TECHNIQUES

Percutaneous mitral valvuloplasty is a non-surgical procedure for trea ting mitral stenosis. There are two techniques of performing this proc edure, the double balloon and the Inoue techniques. The aim of this st udy was to compare the immediate complications of percutaneous mitral valvuloplasty in two consecutive series of unselected patients undergo ing the double balloon (131 patients) and the Inoue (131 patients) tec hniques. The two series were comparable before valvuplasty with respec t to demographic, clinical, echocardiographic and haemodynamic criteri a. The increase in valvular surface area and the decrease in pressure gradient after valvuloplasty were not significantly different (1.1+/-0 .2 to 1.95+/-0.5 cm(2) in the Inoue series and 1.0+/-0.2 to 1.95+/-0.5 cm(2) in the double-balloon series; 12+/-3 to 5+/-2 mmHg in the Inoue series and 13+/-4 to 5+/-2 mmHg in the double-balloon series for the mean transvalvular pressure gradient). A good immediate result ws defi ned as a valve surface area > 1.5 cm(2) and less than or equal to 2+ m itral regurgitation after the series, and this was obtained in 78% of cases in both series. Severe mitral regurgitation (3 +) requiring imme diate or elective mitral valve replacement was observed in 7 cases in the Inoue series and in 5 cases in the double-balloon series (NS). One cerebral embolism occurred in the double balloon series and two syste mic embolisms, one cerebral and one coronary, in the Inoue series. One case of tamponade and two pericardial effusions without tamponade wer e observed in the double-balloon series and two pericardial effusions without tamponade were observed in the Inoue series. There were 8 case s of gas embolisms due to balloon rupture in the double-balloon series . A tear in the balloon mesh without gas embolism was observed in 2 ca ses in the Inoue series requiring replacement of the instrument. The d uration of the procedure and fluoroscopy time were significantly lower in the Inoue series (104+/-13 min versus 123+/-23 min, p<0.02 and 16/-6 min versus 24+/-12 min, p<0.02, respectively). The authors conclud e that the results of mitral valvuloplasty by the Inoue and double bal loon techniques are equivalent but with a lower complication rate and a shorter procedure time with Inoue's technique. On the other hand, th e incidence of severe mitral regurgitation is the same with both techn iques.