BALLOON MITRAL VALVULOPLASTY - OUR EXPERIENCE WITH A MODIFIED TECHNIQUE OF CROSSING THE MITRAL-VALVE IN DIFFICULT CASES

The efficacy and safety of percutaneous transvenous mitral commissurot omy performed by the Inoue technique is well known. In cases with crit ical mitral stenosis and when there is abnormal bulge of the interatri al septum, the usual direct method of crossing the mitral valve may no t be successful, In such cases alternative over-the-wire techniques to cross the mitral valve have been advocated by various authors. In thi s report of 32 cases, we present our experience with the modified and simplified version of over-the-wire technique of crossing the mitral v alve in technically difficult cases, This technique involves direct po sitioning of a pigtail Inoue wire into the left ventricle through the Mullin sheath followed by introduction of an Inoue catheter over the w ire. The mitral valve could be crossed in 30 cases (93.75%). There wer e no major complications attributable to this technique. Frequent vent ricular premature beats (100%) and episodes of nonsustained ventricula r tachycardia (90%) were seen in most of the cases. We conclude that o ur modification of the over-the-wire technique is safe, effective, and does not require any additional accessories. Using this technique, pe rcutaneous transvenous mitral commissurotomy could be performed, even in difficult cases wherein the conventional method of crossing the mit ral valve has failed. (C) 1998 Wiley-Liss, Inc.