TRAUMATIC DAMAGE TO THE MITRAL-VALVE DURING PERCUTANEOUS BALLOON VALVOTOMY FOR CRITICAL AORTIC-STENOSIS

Percutaneous balloon valvuloplasty is now a widely accepted alternativ e to surgical valvotomy for patients with congenital aortic valve sten osis. Mitral valve anomalies are well known to coexist and influence t he prognosis from all palliative procedures. Two cases of mitral valve injury occurring during balloon aortic valvuloplasty are reported, on e an 11 month old boy, the other a 2 day old baby boy. Both cases were characterised by an unusually posterior position of the guidewire, ov er which the balloon was deployed. The wire, and hence the balloon, ma y have been placed through the tension apparatus of the mitral valve w ith subsequent damage to its free edge on inflation. This is at least conceptually more likely to occur if the orifice of the valve is poste rior, if there is a small left ventricular cavity, or if the mitral va lve itself is abnormal--features present in both cases. Possible strat egies for decreasing the incidence of such damage are considered.