RETROGRADE NONTRANSSEPTAL BALLOON MITRAL VALVULOPLASTY USING A MODIFIED INOUE BALLOON CATHETER

Retrograde nontransseptal balloon mitral valvuloplasty, a method devel oped in our institution for the treatment of symptomatic mitral stenos is, avoids transseptal catheterization. Until recently, the self-posit ioning Inoue balloon catheter, unlike all other commercially available balloon catheters, had not been employed in this nontransseptal techn ique due to the short length of its catheter shaft. To employ a self-p ositioning balloon in retrograde nontransseptal balloon mitral valvulo plasty, we modified the Inoue device by extension of the catheter shaf t. After retrograde nontransseptal left atrial catheterization using a steerable cardiac catheter, the modified Inoue balloon catheter was i nserted through the femoral artery and advanced to the mitral valve re trogradely. Valvuloplasty was performed in 20 patients, with a success ful result achieved in all. The modified Inoue balloon catheter was ea sy to use in retrograde nontransseptal balloon mitral valvuloplasty an d showed excellent stability during inflation. Mean mitral valve area increased from 1.0 +/- 0.29 to 2.23 +/- 0.64 cm(2) (P<0.001) and mean transmitral gradient decreased from 11.4 +/- 6 to 4.3 +/- 2.1 mm Hg (P <0.001). No major or minor complications were observed. Retrograde non transseptal balloon mitral valvuloplasty using a modified Inoue balloo n catheter is a feasible and effective technique for the treatment of symtomatic mitral stenosis. It appears to combine the advantages of av oiding transseptal catheterization with the advantages of this balloon 's special configuration. (C) 1994 Wiley-Liss, Inc.