A COMPARISON OF CYLINDRICAL AND INOUE BALLOON TECHNIQUES FOR MITRAL VALVOTOMY IN PATIENTS IN THE UNITED-KINGDOM

Objectives-To compare the use of cylindrical balloons and the Inoue ba lloon for percutaneous mitral valvotomy in patients in the United King dom. Design-Comparison of the haemodynamic results, complications, and symptomatic outcome of ballon dilatation for mitral stenosis in conse cutive patients treated by cylindrical balloons and a second consecuti ve series of patients treated by the Inoue balloon. Setting-A tertiary cardiac referral centre in Scotland. Patients-70 patients (mean age 6 0.6 years) treated by the single or double cylindrical balloon techniq ue and 70 patients (mean age 58.9 years) treated with the Inoue balloo n method. Main outcome measures-Success in obtaining dilatation at the mitral orifice, procedure and screening times, increase in valve area , complications, and early symptomatic outcome. Results-Dilatation of the mitral valve was obtained in 91% of patients when cylindrical ball oons were used and in 99% of patients treated with the Inoue balloon. Use of the Inoue balloon gave significantly shorter procedure and scre ening times. Technical problems in obtaining and maintaining the posit ion at the mitral orifice were more common with cylindrical balloons. Improvements in valve area and symptoms were not significantly differe nt with use of the two types of balloon. The Inoue balloon avoided car diac tamponade and the creation of larger atrial septal defects, but h ad a higher incidence of increase in mitral reflux. Conclusions-In the se elderly patients, the Inoue balloon method was safer and faster for percutaneous mitral valvotomy, with a higher success rate for dilatat ion within the valve orifice. Haemodynamic and symptomatic improvement was similar with the two techniques.