Balloon aortic valvuloplasty revisited: the role of the inoue balloon and transseptal antegrade approach.

Percutaneous aortic balloon valvuloplasty (PABV) was developed to provide a less invasive alternative to aortic valve replacement. Despite initially favorable results, PABV has not produced reliable and durable outcomes. The Inoue balloon used for PABV via an antegrade transseptal approach may offer an improvement over the Mansfield balloons via the identical route. Thirteen consecutive patients with severe symptomatic aortic stenosis were referred for percutaneous aortic balloon valvuloplasty. All patients were considered unacceptably high-risk surgical candidates. Seven consecutive patients underwent antegrade transseptal PABV with Mansfield balloons and in the following six the Inoue balloon was used. The study group was characterized by advanced age (mean, 77) and multiple comorbid conditions (mean, 2.5/patient). Before PABV, the two groups did not differ with respect to age, mean NYHA class, LVEF, transaortic gradient, cardiac output, or aortic valve area. All patients had initial hemodynamic improvement. Complications included one stroke and one vascular injury. After valvuloplasty, cardiac output was not significantly changed. However, there was a significant decrease in aortic gradient and an increase in aortic valve area in both groups; the increase in aortic valve area was significantly greater in those treated with the Inoue balloon (P = 0. 039). Total follow-up mortality was high but appeared to be delayed in the Inoue group. The use of the Inoue balloon with an antegrade transseptal approach warrants further investigation as a preferred technique for PABV.     

Balloon valvotomy for pregnant patients with severe pliable mitral stenosis using the Inoue technique with total abdominal and pelvic shielding.

Balloon valvotomy by means of the Inoue technique was attempted in seven pregnant (5 to 9 months) patients with severe mitral stenosis; the mean age of the patients was 32 +/- 8 years, and all had a two-dimensional echocardiographic mitral valve score of < 8. Indications for Inoue balloon valvotomy included severe symptomatic mitral stenosis with a Doppler mitral valve area < or = 1 cm2 and heart failure refractory to medical therapy, or absolute contraindications for the use of beta-blockade; Inoue valvotomy was also indicated for patients who lived a long distance from the hospital. Inoue balloon valvotomy was performed with no angiography and total pelvic and abdominal shielding; the balloon catheter was introduced into the right atrium without the aid of fluoroscopy, which was used for the transseptal puncture. Stepwise two-dimensional echocardiographic Doppler mitral valve dilatation was done. After Inoue balloon valvotomy the mean Doppler mitral valve area increased from 0.8 +/- 0.1 to 2.0 +/- 0.3 cm2 (p < 0.01) and by two-dimensional echocardiography from 0.8 +/- 0.2 to 1.9 +/- 0.3 cm2 (p < 0.01), with no significant Doppler residual stenosis (defined as mitral valve area < or = 1.5 cm2). The mean total fluoroscopy time was 16 +/- 7 minutes. The degree of mitral regurgitation increased in two patients from grade 1+/4+ to grade 2+/4+ and from grade 0+/4+ to grade 2+/4+, respectively. There was no mortality or significant morbidity. Pregnancy was uneventful in all patients, and all were delivered of normal babies without complications.(ABSTRACT TRUNCATED AT 250 WORDS)     

Balloon diameter of the Inoue balloon catheter during percutaneous transvenous mitral commissurotomy: clinical and experimental study

To determine adequate and effective balloon diameters of the Inoue balloon catheter, we reviewed clinical results and characteristics of the Inoue balloon catheter, especially the relationship between the intra-balloon pressure and the balloon diameter, experimentally and clinically, in 46 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Mitral valve area increased from 1.1 +/- 0.3 to 2.1 +/- 0.3 cm2 in all patients after PTMC. Based on balloon diameter settings, mitral valve area increased from 1.3 +/- 0.4 to 2.3 +/- 0.5 cm2 in patients treated with a balloon setting greater than 26 mm in diameter, from 1.1 +/- 0.3 to 2.0 +/- 0.5 cm2 in patients with a balloon setting at 26 mm in diameter, and from 1.1 +/- 0.4 to 1.7 +/- 0.4 cm2 in those treated with a balloon setting less than 26 mm in diameter, with an increase in mitral valve area of 1.0 +/- 0.6, 0.9 +/- 0.4, and 0.7 +/- 0.2 cm2, respectively. There was a significant difference between the increase in mitral valve area at a setting of 26 mm in diameter and that observed at a setting less than 26 mm in diameter. We next investigated differences between balloon diameter settings and actual balloon diameters measured from cineangiograms at maximum balloon inflation. The ratio of actual balloon diameter to a setting diameter of less than 26 mm was smaller than that of 26 mm. To evaluate the reason for the difference, we investigated the relationship between intra-balloon pressure and balloon diameter. In the prototype Inoue balloon catheter, intra-balloon pressure increases from 1.0 kg/cm2 at 20 mm in diameter to 2.2 kg/cm2 at 30 mm in diameter at atmospheric pressure. In conclusion, the increase in mitral valve area was inadequate when the balloon was less than 26 mm in diameter because of inadequate intra-balloon pressure. We, therefore, recommend a balloon size set above 26 mm to obtain adequate intra-balloon pressure when using the Inoue balloon catheter.     

Balloon aortic valvuloplasty in young adults by antegrade,transseptal approach using Inoue balloon

Transvenous, transseptal, antegrade balloon aortic valvuloplasty (BAV) was successfully performed in 16 consecutive young adults with noncalcific aortic stenosis using Inoue balloon catheter. There were 13 males and three females, with a mean age of 20.4 ± 5.8 years (range 14–30 years). All the patients had normal left ventricular systolic function. All procedures were performed electively by the antegrade technique, except the initial index case in whom, the stenosed aortic valve could not be crossed retrogradely. Dilatation was performed using stepwise technique keeping the balloon:annulus ratio ≤100% in all the cases. Transaortic peak systolic gradient decreased from 113.4 ± 42.6 (range 70–210) mm Hg to 11.2 ± 9.2 (range 4–32) mm Hg; P = 0.0005. Following BAV, three patients developed grade 2⁺ aortic regurgitation, who were managed medically. None of the patients developed tamponade, vascular complications, excessive bleeding, or thromboembolism. Significant left to right atrial shunt (Qp/Qs ≥ 1.5:1) was observed in one case. The average procedure time was 20 ± 8 min (range 18–35 min). On follow-up (n = 11 patients) at 4 ± 1.5 months (range 2–7 months) all the patients were asymptomatic. Doppler transaortic peak systolic gradient was found to be 15 ± 10.3 mm Hg (range 4–36 mm Hg). Antegrade BAV technique using Inoue balloon for noncalcific aortic stenosis in young adults is safe, effective and may be technically advantageous. Cathet. Cardiovasc. Diagn. 44:297–301, 1998. © 1998 Wiley-Liss, Inc.     

Inoue balloon deformity and rupture during percutaneous balloon valvuloplasty

In the management of mitral stenosis, similar long-term results can be obtained by using either an Inoue balloon catheter or a double-balloon technique for percutaneous balloon valvuloplasty. There have been few reports concerning any deformity of an Inoue balloon. From January 1988 to June 1995, 263 procedures of either mitral or tricuspid valvuloplasty have been performed in this center. The Inoue balloon catheter technique was used for 245 procedures. A deformity of the Inoue balloon catheter was noted in 4 (1.6%) and actual rupture of deformed balloon occurred in one (0.4%). All deformities were found at the distal portion of the Inoue balloon. Valvular insufficiency became more severe after valvuloplasty in two cases. Following rupture of the balloon, neither arterial embolization nor perforation of the cardiac chambers developed. In conclusion, a deformity of the Inoue balloon, although rare, can develop during percutaneous balloon valvuloplasty. The deformity may portend balloon rupture if additional maximal dilatations are undertaken. © 1996 Wiley-Liss, Inc.     

Balloon Mitral and Aortic Valvuloplasty in Mirror-Image Dextrocardia

Three patients of mirror-image dextrocardia were subjected to balloon valvuloplasty at our institute. One patient had severe pliable rheumatic mitral stenosis (MS), another had severe calcific rheumatic MS and the third had moderate rheumatic MS and severe rheumatic aortic stenosis (AS). Necessary modifications in the standard septal puncture technique, Inoue mitral valvuloplasty technique, and Cribier aortic valvuloplasty technique were done keeping unusual anatomy of mirror-image dextrocardia in account to dilate mitral and aortic stenosis successfully. Acute hemodynamic results were satisfactory and no complications encountered. This report illustrates feasibility and safety of balloon mitral and aortic valvuloplasty in the complex cardiac anatomy of situs inversus totalis.     

Balloon mitral valvotomy after surgical commissurotomy: clinical and hemodynamic results of a large, single-center study

BACKGROUND AND AIM OF THE STUDY: Patients with restenosis after open or closed surgical commissurotomy (SC) often demonstrate more severe valve degeneration than patients without prior surgery. This may affect the result of balloon mitral valvotomy (BMV) in this patient group. METHODS: The immediate- and long-term results (maximum 106 months; mean 26 months) of BMV with the Inoue balloon in patients with prior SC were compared with findings in patients without prior surgery. Between February 1989 and July 2001, a total of 1,156 BMV interventions was performed, of which 127 were conducted in patients (106 women, 21 men; mean age 56 +/- 12 years) with prior SC. RESULTS: After BMV, the mitral valve area (MVA) increased from 1.0 +/- 0.2 cm2 to 1.6 +/- 0.4 cm2 after SC compared with 1.0 +/- 0.3 cm2 to 1.8 +/- 0.4 cm2 without SC. After three months, the average MVA was 1.7 +/- 0.3 cm2 in both patient groups. The mean NYHA class improved from 2.8 to 2.0 (after SC) versus 2.7 to 1.8 (no SC) three months after BMV. The main complications were cardiac tamponade in three patients (2.4 %), and more than moderate mitral regurgitation (grade 2+) in six (4.7 %) compared to 5.8% in no-SC patients. CONCLUSION: In view of the satisfactory clinical and hemodynamic results, BMV with the Inoue balloon can be considered the treatment of choice for mitral valve restenosis after SC in selected patients.     

Comparative Study Between Various Methods of Percutaneous Transvenous Mitral Commissurotomy Metallic Valvotome, Inoue Balloon, and Double-Balloon Techniques (VID) Study

The aim of this study was to compare the immediate results of percutaneous mitral commissurotomy using metallic valvotome, Inoue balloon, or double‐balloon techniques. We conducted a randomized trial comparing the immediate results of the three procedures in 150 patients (50 patients in each group) who were rheumatic mitral stenosis candidates for valvuloplasty. The procedures used per group were metallic valvotome (group I), Inoue balloon (group II), and double balloon (group III). The three groups were similar in age, sex, MVA, transmitral PG, LV function, predicted PAP, and presence of mitral re gurgitation. Patients in group I had a higher MV score (>9) than group II and III. The MVA was increased by a similar degree in groups I and III (2.1 ± 0.5 cm², 2.0 ± 1.2 cm²) but greater than group II (1.87 ± 0.4 cm²) (P = 0.01). Mean transmitral PG was lower in group III (4.3 ± 1.9 mmHg) than in groups I and II (6.3 ± 3.7 mmHg, 6.3 ± 5.3 mmHg), respectively (P = 0.01). Echocardiographic data showed a higher depth score of posterior commissural splitting in groups I and III (0.7 ± 0.3 cm, 0.8 ± 0.3 cm, respectively) than in group II (0.6 ± 0.3) (P = 0.006), while the depth score of anterior commissure splitting was comparable in all groups (0.6 ± 0.3, 0.6 ± 0.3, and 0.7 ± 0.3, respectively) (P = 0.4). Stepwise multivariate regression analysis revealed that the following variables significantly affect the success of valvuloplasty as evidenced by a MVA ≥ 1.5 cm². (1) techniques, the larger MVA was achieved by valvotome and double balloon (P = 0.0001); (2) MVA before valvuloplasty, the larger the MVA before, the larger the MVA after (P = 0.0008); (3) valve thickness, the more the thickness, the smaller the achieved MVA (P = 0.01); und (4) valve mobility, the more limited mobility, the smaller the MVA (P = 0.007). Small and restrictive ASD was present in 14 (28%) patients in group I, 2 (4%) patients in group II, and 3 (6%) patients in group III. Changes in grade of mitral regurgitation was comparable in all groups as the grade increased by I grade (40% in group I, 36% in group II, and 36% in group III). In contrast to the Inoue balloon technique, the metallic valvotome, and double‐balloon technique produced an excellent and comparable early improvement of MVA associated with minimal complications. However, the good results achieved with patients who had a higher MV score (≥9) by metallic valvotome and lower cost indicate that metallic valvotome should be the treatment of choice for tight mitral stenosis.     

The Indian Experience of Percutaneous Transvenous Mitral Commissurotomy: Comparison of the Triple Lumen (Inoue) and Double Lumen (Accura) Variable Sized Single Balloon With Regard to Procedural Outcome and Cost Savings

The efficacy, safety, and cost of percutaneous mitral commissurotomy (PTMC), using variable volume dependent sized catheters, compared a triple lumen (Inoue) with a double lumen (Accura) catheter. PTMC was performed using Accura balloons in 400 patients and Inoue balloons in 512 patients. The group demographics, increase in mitral valve area, and incidence of significant complications were similar. The catheters were similar with respect to maneuverability and procedure (fluoroscopy) time. The Accura balloons could be reutilized statistically more often (6.3 ± 1.4 for Accura and 5.2 ± 0.8 for Inoue, P < 0.05). Accura balloons were more cost-effective, with 6.3 usages lowering the per procedural catheter cost to $214.00, while the Inoue balloons, with 5.2 usages, had a final catheter cost of $395.00. The potential savings would have been $155,340.00 if Accura balloons were utilized. Conclusions: Accura and Inoue mitral valvuloplasty balloons were comparable with regard to efficacy and safety, but the Accura balloon was significantly less costly and is therefore more suitable for use in India and other nations where resources are limited.     

Immediate and 18‐Month Outcome of Balloon Mitral Valvuloplasty: Comparison of Inoue and Multi‐Track System

Aims: To compare the immediate and 18‐month clinical and echocardiographic outcome of Inoue and multi‐track system for balloon mitral valvuloplasty (BMV). Methods: We included 78 consecutive patients with moderate to severe rheumatic mitral stenosis (MS) [mitral valve area (MVA) < 1.5 cm²] and clinically indicated BMV. The first 42 consecutive patients were assigned to Inoue BMV (group I), and the following 36 consecutive patients were assigned to multi‐track system (group M). Clinical and echocardiographic assessment was performed before, immediately after, 3 months after, and 18 months after the procedure. Results: The successful immediate result [MVA > 1.5 cm² and mitral regurgitation (MR) < II/IV] was achieved in 40 (95.23%) patients of group I and 34 (94.44%) patients of group M (P = 0.12). Immediately after BMV, MVA increased from 0.9 ± 0.4 to 1.7 ± 0.5 cm² in group I and from 0.8 ± 0.2 to 1.9 ± 0.3 cm² in group M (P < 0.01). Bilateral commissural splitting was significantly higher in group M (P < 0.01). This was associated with higher incidence of mild commissural mitral regurgitation. There were no significant differences of moderate to severe MR. Both procedure and fluoroscopy time were significantly shorter in group I (P < 0.001). Eighteen‐month clinical and echocardiographic evaluation was available for 66 (84.64%) patients with sustained immediate clinical and echocardiographic improvements. Conclusions: Both Inoue and the multi‐track balloon systems achieved successful immediate and 18‐month results. The multi‐track double balloon system produced significantly larger MVA, with better bilateral commissurotomy, yet with longer procedure and fluoroscopy times. (J Interven Cardiol 2012;25:47–52)     

Retrograde nontransseptal balloon mitral valvuloplasty using a modified inoue balloon catheter

Retrograde nontransseptal balloon mitral valvuloplasty, a method developed in our institution for the treatment of symptomatic mitral stenosis, avoids transseptal catheterization. Until recently, the self-positioning Inoue balloon catheter, unlike all other commercially available balloon catheters, had not been employed in this nontransseptal technique due to the short length of its catheter shaft. To employ a self-positioning balloon in retrograde nontransseptal balloon mitral valvuloplasty, we modified the Inoue device by extension of the catheter shaft. After retrograde nontransseptal left atrial catheterization using a steerable cardiac catheter, the modified Inoue balloon catheter was inserted through the femoral artery and advanced to the mitral valve retrogradely. Valvuloplasty was performed in 20 patients, with a successful result achieved in all. The modified Inoue balloon catheter was easy to use in retrograde nontransseptal balloon mitral valvuioplasty and showed excellent stability during inflation. Mean mitral valve area increased from 1.0 ± 0.29 to 2.23 ± 0.64 cm² (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 nontransseptal balloon mitral valvuloplasty using a modified Inoue balloon catheter is a feasible and effective technique for the treatment of symtomatic mitral stenosis. It appears to combine the advantages of avoiding transseptal catheterization with the advantages of this balloon's special configuration. © Wiley-Liss, Inc.     

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 balloon for percutaneous mitral valvotomy in patients in the United Kingdom. DESIGN--Comparison of the haemodynamic results, complications, and symptomatic outcome of balloon dilatation for mitral stenosis in consecutive patients treated by cylindrical balloons and a second consecutive series of patients treated by the Inoue balloon. SETTING--A tertiary cardiac referral centre in Scotland. PATIENTS--70 patients (mean age 60.6 years) treated by the single or double cylindrical balloon technique and 70 patients (mean age 58.9 years) treated with the Inoue balloon 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 balloons were used and in 99% of patients treated with the Inoue balloon. Use of the Inoue balloon gave significantly shorter procedure and screening times. Technical problems in obtaining and maintaining the position at the mitral orifice were more common with cylindrical balloons. Improvements in valve area and symptoms were not significantly different with use of the two types of balloon. The Inoue balloon avoided cardiac tamponade and the creation of larger atrial septal defects, but had a higher incidence of increase in mitral reflux. CONCLUSIONS--In these elderly patients, the Inoue balloon method was safer and faster for percutaneous mitral valvotomy, with a higher success rate for dilatation within the valve orifice. Haemodynamic and symptomatic improvement was similar with the two techniques.     

应用国产球囊导管经皮穿刺进行二尖瓣球囊成形术(附57例分析)

应用国产球囊导管,对57例风湿性心脏病二尖瓣狭窄患者进行经皮穿刺二尖瓣球囊成形术(PTMC)男性22例,女性35例,年龄22～51岁,病程4～25年,伴发房颤13例.瓣口面积0.67～1.4cm~2.在原有PTMC方法基础上进行了改进,采用球囊导管60～90度方向进入股静脉;创新采用三法定位校正法,进行房间隔穿刺;创新采用球囊导管反“C”字法进入狭窄的二尖瓣口.成功率96.5%,使手术时间出平均1.5～2.0/小时,缩短到40～50分钟,使x线曝光时间降至30分钟.本组国产球囊与Inoue球整操作过程中无明显差别.     

“Balloon impasse”: A marker for severe mitral subvalvular disease and a predictor of mitral regurgitation in inoue-balloon percutaneous transvenous mitral commissurotomy

In certain instances of percutaneous transvenous mitral commissurotomy, the Inoue catheter balloon, although deflated and properly aligned, becomes held up or checked at the mitral valve. This “balloon impasse,” observed in 13 of 760 patients undergoing the commissurotomy, reflects severe obstructive subvalvular disease even though echocardiographic evidence suggests otherwise. Our experience shows that the sign portends severe mitral regurgitation if the usual balloon sizing method is used. Such a situation occurred with four of the first six patients. In the next seven patients, the use of smaller balloon catheters (PTMC-18 or PTMC-20) for the initial set of stepwise dilatations averted creation of severe mitral regurgitation. When the “balloon impasse” sign is encountered during the commissurotomy procedure, the catheter selection and balloon sizing method should be judiciously altered. © 1995 Wiley-Liss. Inc.     

Mitral Balloon Valvuloplasty as an Outpatient Procedure Using Inoue Balloon Technique

Objective: To evaluate the safety and feasibility of mitral balloon valvuloplasty (MBV) as an outpatient procedure. Background: MBV is usually done as an inpatient procedure, requiring 3–4 days of hospital admission. Only one report is available about MBV as a day case procedure in the English literature. Methods: Between October 1994 and December 1996, 128 patients underwent MBV using an Inoue balloon. Of those, 31 patients (Group I) had the procedure as outpatients and 97 patients (Group II) as inpatients. Their mean age in Group I was 29 ± 9 years and in Group II 32 ± 10 years (P < 0.3). Atrial fibrillation was present in 4 patients in Group I and in 13 patients in Group II (P < 0.99). Results: Hemodynamic study revealed that mitral valve area increased from 0.9 ± 0.2 to 1.9 ± 0.5 cm²* in Group I and from 0.8 ± 0.2 to 1.7 ± 0.5 cm²* in Group II, Left atrial pressure decreased from 24 ± 5 to 15 ±6 mm Hg* in Group I and 24 ± 6 to 16 ± 5 mmHg in Group II.* Mitral valve gradient decreased from 15 + 5 to 5 + 2 mmHg in Group I and 15 + 5 to 6 + 3 mmHg in Group II* (*P < 0.001). Patients in Group I stayed in the Preadmission Unit for a mean period of 9.5 ± 2.5 hours. Patients in Group II stayed for a mean of 2.5 days in the hospital. Severe mitral regurgitation developed in one patient in each Group and needed semiurgent mitral valve replacement without sequela. No death, convulsions, or thromboembolism were encountered, and three patients in both Groups developed minor hematoma and needed no additional treatment. Conclusion: MBV as an outpatient procedure is feasible and safe and could significantly decrease the cost of medical care.     

采用不同球囊行肺动脉瓣成形术

对２５例肺动脉瓣狭窄患者行经皮球囊扩张术，探讨（Ｍａｎｓｆｉｅｌｄ球囊和Ｉｎｏｕｅ球囊对手术效果的影响及其优缺点。结果表明：Ｉｎｏｕｅ球囊导管进行经皮肺动脉瓣扩张术可取得与Ｍａｎｓｆｉｅｌｄ球囊导管法相似的疗效，但比Ｍａｎｓｆｉｅｌｄ球囊导管法具有更多的优点，如操作简便、可顺序扩张，并发症少等。     

Percutaneous balloon mitral valvotomy in pregnancy using the Inoue balloon catheter.

Percutaneous balloon mitral valvotomy (PBMV) using the Inoue balloon catheter was performed successfully in 2 patients with severe mitral stenosis refractory to medical treatment during pregnancy. Because of its unique design and ease of manipulation, we recommend the Inoue balloon catheter for performing PBMV in selected patients with mitral stenosis during pregnancy, as procedure and fluoroscopy times can be significantly shortened.     

Echocardiography can predict the development of severe mitral regurgitation after percutaneous mitral valvuloplasty by the Inoue technique

Severe mitral regurgitation (MR) following mitral balloon valvuloplasty is a major complication of this procedure. We recently described a new echocardiographic score that can predict the development of severe MR following mitral valvuloplasty with the double balloon technique. The present study was designed to test the usefulness of this score for predicting severe MR in patients undergoing the procedure using the Inoue balloon technique. From 117 consecutive patients who underwent mitral valvuloplasty using the Inoue technique, 14 (11.9%) developed severe MR after the procedure. A good quality echocardiogram before mitral valvuloplasty was available in 11 patients. These 11 patients were matched by age, sex, mitral valve area, and degree of MR before valvuloplasty with 69 randomly selected patients who did not develop severe MR after Inoue valvuloplasty. The total MR-echocardiographic (MR-echo) score was significantly greater in the severe MR group (10.5 +/- 1.4 vs 8.2 +/- 1.1; p <0.001). In addition, the component grades for the anterior leaflet (2.9 +/- 0.5 vs 2.2 +/- 0.4; p <0.001), posterior leaflet (2.6 +/- 0.7 vs 1.9 +/- 0.8), commissures (2.4 +/- 0.8 vs 2.0 +/- 0.5; p <0.05) and subvalvular apparatus (2.6 +/- 0.5 vs 1.9 +/- 0.4; p <0.001) were also higher in the MR group. Using a total score of > or = 10 as a cut-off point for predicting severe MR with the Inoue technique, a sensitivity of 82%, specificity of 91%, accuracy of 90%, and negative predictive value of 97% were obtained. Stepwise logistic regression analysis identified the MR-echo score as the only independent predictor for developing severe MR with the Inoue technique (p <0.0001). Thus, the MR-echo score can also predict the development of severe MR following mitral balloon valvuloplasty using the Inoue technique.     

Balloon mitral valvotomy: comparison between antegrade Inoue and retrograde non-transseptal techniques

AIMS: The results of percutaneous mitral valvotomy performed by theantegrade transseptal method using the Inoue balloon (n=1000;group 1) and by the retrograde non-transseptal technique usinga polyethylene balloon (n=100; group 2) were compared in a retrospective,non-randomized study. METHODS AND RESULTS: Both the groups were similar with respect to baseline characteristics.The success rate was 95% in group 1 and 93% in group 2. Therewas a significant increase in mitral valve area estimated byGorlin's equation (Group 1: from 0·8 ± 0·5to 2·1 ± 0·8 cm²; Group 2: from 0·8± 0·3 to 1·9 ± 0·8 cm², bothP<0·001) and by Doppler echocardiography using thepressure half-time method (Group 1: from 0·9 ±0·4 to 2·2 ± 0·6 cm²; Group 2: from0·9 ± 0·3 to 2·0 ± 0·7cm², both P<0·001). However, the calculated immediatepost-valvotomy mitral valve area was larger with the Inoue technique(2·1 ± 0·8 vs 1·9 ± 0·8cm²; P<0·02). Results were considered optimal whenthe mitral valve area increased to 1·5 cm², the percentageincrease was 50, and mitral regurgitation was 2/4. Out of thetotal successful procedures, optimal results were obtained in95% patients in Group 1 and 94% in Group 2. Incidence of significantmitral regurgitation (grade 3/4) was similar in two groups (Group1: 4% vs Group 2: 5%, P=ns). A significant left to right atrialshunt (Qp/Qs 1·5:1) in 2·5% and tamponade in2% of cases occurred exclusively with the Inoue technique, whileconduction disturbances, such as transient (<24 h) left bundlebranch block (28%) and complete heart block (2%) were notedwith the retrograde technique (Group 2). Local complicationswere significantly higher in Group 2 (3% vs 0·5%, P<0·01).The procedure time with the Inoue technique was shorter thanwith the retrograde (Group 1: 15 ± 8, range 10 to 35min; Group 2: 22 ± 14, range 15 to 45 min, P=0·05).Echocardiographic follow-up at 1 year showed no significantdifference in mitral valve area between the two groups (Group1 (n=300): 1·8 ± 0·8 vs Group 2 (n=60):1·9 ± 0·9 cm²; P=0·3). CONCLUSION: Balloon mitral valvotomy using the Inoue balloon and the retrogradenon-transseptal technique results in significant immediate haemodynamicand symptomatic improvement. The Inoue technique achieved alarger immediate post-valvotomy mitral valve area, but the differencewas not apparent at 1 year follow-up. Incidence of significantmitral regurgitation was similar with both the techniques; however,local complications occurred more frequently with the retrogradetechnique. Both techniques may complement each other in technicallydifficult cases.     

鞘管轨道在Inoue球囊导管进入股静脉中的应用

目的探讨自制鞘管轨道在解决经皮二尖瓣球囊扩张术（PBMV）中Inoue球囊导管沿左心房钢丝进入股静脉困难时的应用,并评价其可行性和安全性。方法 2008年1月至2014年6月在长海医院心内科住院的风湿性二尖瓣狭窄拟行经皮二尖瓣Inoue球囊扩张术的患者共136例,以术中出现Inoue球囊导管沿左心房钢丝进入股静脉困难的18例患者作为研究对象,采用7 F桡动脉血管鞘制作鞘管轨道引导Inoue球囊进入股静脉,观察Inoue球囊导入股静脉的成功率、手术成功率和穿刺处血管并发症。结果在鞘管轨道的辅助下,18例患者均成功将Inoue球囊导入股静脉,手术成功率100%,术后股静脉穿刺处未见静脉撕脱、皮下血肿等并发症发生。结论对于PBMV中Inoue球囊导管沿左心房钢丝进入股静脉困难的患者,使用鞘管轨道能够解决,顺利完成手术并避免穿刺部位出现血管并发症。