彩色多普勒超声心动图在经皮球囊二尖瓣成形术中的应用

彩色多普勒超声心动图在经皮球囊二尖瓣成形术中的应用山东省千佛山医院（２５００１４）乔建华，周聊生，娄兹谟１９９１年以来，我们将彩色多普勒超声心动图检测用于二尖瓣球囊成形术（ＰＢＭＶ），用其术前确定二尖瓣病变程度，术中引导球囊导管位置，术后评价疗效，共...     

风湿性二尖瓣狭窄球囊成形术的临床应用

为了观察经皮球囊成形术（ＰＢＭＶ）对风湿性二尖瓣狭窄的临床疗效，对２９３例风湿性二尖瓣狭窄病人进行ＰＢＭＶ治疗。结果表明：（１）ＰＢＭＶ的成功率为９９％，术后即刻血流明显动力学明显改善，其中５２例外科术后再狭窄和４５例并存二尖瓣、主动脉瓣关闭不全的患者也获得了与原发性狭窄和单纯性狭窄相似的临床效果。（２）１０５例病人并发心房纤颤，１０３例ＰＢＭＶ成功，无１例发生栓塞并发症，术后１０２例接受复律治疗     

老年风湿性心脏病患者经皮二尖瓣球囊成形术21例分析

目的评估经皮二尖瓣球囊成形术（ＰＢＭＶ）治疗老年人风湿性心脏病的疗效。方法分析老年风湿性心脏病二尖瓣狭窄患者行ＰＢＭＶ术前、术后超声心动图、血流动力学指标及心功能状况。结果２１例行ＰＢＭＶ，２０例成功，成功率９５．２％；未发生严重并发症，仅１例因瓣膜明显均质性致密增厚而扩张失效。平均随访９±３个月，ＰＢＭＶ术后二尖瓣口面积从１．１２±０．２５ｃｍ２增加至１．８９±０．２７ｃｍ２，左房平均压从３．４０±１．０８ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降至１．７２±０．７５ｋＰａ，术后心功能改善１级者６例，改善２级及以上者１４例，手术失败１例心功能无改善。结论ＰＢＭＶ是老年风湿性心脏病二尖瓣狭窄患者安全、有效的治疗措施之一。     

经皮球囊二尖瓣成形术前后三种计算二尖瓣口面积方法的比较

对３３例以二尖瓣狭窄为主的风湿性心脏病患者进行研究，比较了经皮球囊二尖瓣成形术（ＰＢＭＶ）前后３种计算二尖瓣瓣口面积的方法。统计表明，ＰＢＭＶ前Ｇｏｒｌｉｎ公式，多普勒超声心动图压差减半时间及二维超声心动图测量的二尖瓣口面积间有显著相关，但ＰＢＭＶ后仅二维超声心动图测量二尖瓣口面积（ＭＶＡＥ）与连续波多普勒超声心动图测量二尖瓣口面积（ＭＶＡＤ）维持ＰＢＭＶ前相似的相关性；３种方法计算的瓣口面积在ＰＢＭＶ前后的变化率亦不相关。ＰＢＭＶ后血液动力学改变对Ｇｏｒｌｉｎ公式及压差减半时间计算的二尖瓣口面积有明显影响，３种计算二尖瓣口面积的方法不能混用，ＰＢＭＶ术后测量二尖瓣口面积应以二维超声心动图方法为准。     

79例经皮球囊二尖瓣成形术患者10年远期疗效评价

目的评价二尖瓣球囊成形术（ＰＢＭＶ）后１０年以上的远期疗效。方法对７９例ＰＢＭＶ患者进行严格的术后追踪随访,包括超声心动图和临床心功能评价。平均随访时间（１１．２±１．１）年。结果ＰＢＭＶ术后二尖瓣口面积（ＭＶＡ）显著扩大,为（１．０９±０．３２）ｃｍ２与（２．０４±０．４３）ｃｍ２,Ｐ＜００１;随访１０年,ＭＶＡ逐渐减小至（１．４７±０．３６）ｃｍ２,Ｐ＜０．０１;再狭窄率为３９．２％。ＰＢＭＶ术后心功能改善１个级别以上者占９７．５％。术后１０年随访心功能仍然维持在Ⅰ～Ⅱ级而未再次行介入或心脏手术者占７７．２％。术后新出现或轻度加重的二尖瓣反流以及新出现的房间隔分流分别为１２．６％和７．９％,均未引起明显的血流动力学障碍,长期保持良好的心功能。结论ＰＢＭＶ术后１０年以上临床远期疗效良好,未见严重并发症。     

经皮二尖瓣球囊成形术的临床随访研究

目的：评价经皮二尖瓣球囊成形术（ＰＢＭＶ）的临床随访结果。方法：追踪观察１４３例ＰＢＭＶ病人并行彩色多普勒超声心动图检查。将病人分为超声积分≤８和积分＞８两组。描述全部及两组病人５年无事件生存分布。结果：全部病人５年无事件生存率为６９．６０±６．７８％。积分≤８组的生存分布好于积分＞８组（Ｐ＜０．００５）。单因素分析证实窦性心律、无外科分离术史、积分≤８、术前二尖瓣口面积＞１．００ｃｍ２和术后即刻效果良好者无事件生存率较高。结论：多数ＰＢＭＶ病人远期效果良好，积分≤８、窦性心律、无外科分离术史者可能为ＰＢＭＶ最佳适应证。     

风湿性二尖瓣狭窄病人血浆肾上腺髓质素水平变化的初步研究

肾上腺髓质素（ＡＤＭ）是参与心血管活动调节的舒血管活性肽,对病变的心脏有代偿性的保护作用。经皮二尖瓣球囊成形术（ＰＢＭＶ）能使有症状的二尖瓣狭窄病人的短、长期症状及血液动力学状况明显改善。通过测量ＰＢＭＶ术前、后静脉血浆ＡＤＭ浓度值和血液动力学参数,分析二者的关系,来探讨ＡＤＭ在二尖瓣狭窄中的作用和意义。１资料与方法 对象：２０例行ＰＢＭＶ的二尖瓣狭窄病人,年龄３６±岁,心功能（ＮＹＨＡ）分级Ⅱ级１５例,Ⅲ级５例;正常对照１２例,年龄３５±７岁。 方法：ＰＢＭＶ术前及术后第５天常规 Ｈｐ－１５００…     

经皮球囊导管二尖瓣成形术治疗风湿性二尖瓣狭窄的长期随 …

目的 评价经皮球囊导管二尖瓣成形术（ＰＢＭＶ）治疗风湿性二尖瓣狭窄（ＭＳ）的远期疗效。方法 自１９８９年５月至１９９７年１２月对风湿性ＭＳ３３６例患者采用Ｉｎｏｕｅ法行ＰＢＭＶ,对成功的３３０例进行８年的随访,每年随访１次,根据临床症状,心尖部期杂音及第一心音的强度改变、心功能、二维及多普勒超声心动图检测的二尖瓣口面积判断远期疗效。随访时二尖瓣口面积经ＰＢＭＶ后增加的面积缩小５０％以上为再狭窄。结     

经皮二尖瓣球囊扩张术对血浆内皮素及其内分泌的影响(摘要)

经皮二尖瓣球囊扩张术对血浆内皮素及其内分泌的影响（摘要）谢培怡⒇采用放射免疫法测定风湿性心脏病二尖瓣狭窄患者经皮二尖瓣球囊扩张术（ＰＢＭＶ）术前、术后血浆内皮素（ｅｎｄｏｔｈｅｌｉｎ，ＥＴ）、肾素、血管紧张素Ⅱ、心钠素的变化。并与心功能以及血流动力学...     

提高经皮二尖瓣球囊成形术疗效及防止并发症的经验和体会

目的通过１５２例经皮二尖瓣球囊成形术（ＰＢＭＶ）病例分析,总结ＰＢＭＶ术中、术后提高疗效及防止并发症的经验和体会。方法采用Ｉｎｏｕｅ法进行ＰＢＭＶ,并对部分操作技术进行了改进。术后对１１０例病人随访２４±１０个月,观察ＰＢＭＶ术后近期及远期疗效。结果１５２例中１５１例成功,成功率９９５％;长期随访的１１０例患者,７６％心功能稳定于ＮＹＨＡⅠ级,二尖瓣口面积（ＭＶＡ）（２０６±０４０）ｃｍ２,有５３％发生再狭窄,无一例死亡。结论作者认为严格选择病人、熟练地进行房间隔穿刺与球囊扩张、操作人员密切配合及术后预防再狭窄是提高ＰＢＭＶ疗效与避免并发症的关键     

Percutaneous balloon dilatation of the mitral valve in critically ill young patients with intractable heart failure.

OBJECTIVE--To assess the outcome of percutaneous balloon dilatation of the mitral valve in critically ill young patients with intractable heart failure. DESIGN--Retrospective analysis of all such patients presenting over a period of 4 years. PATIENTS--Of 432 consecutive patients undergoing percutaneous balloon dilatation of the mitral valve, 12 (mean age 29 years) with intractable heart failure were identified. Nine had severe pulmonary oedema and three had pulmonary oedema with severe right heart failure and hypotension. Three patients were pregnant and three required mechanical; ventilatory support. PROCEDURE--Percutaneous balloon dilatation of the mitral valve was performed using the Inoue balloon technique. The procedure was shortened by excluding full right study, cardiac output measurement, and left ventriculography. The mitral valve morphology and mitral valve area were determined before and after percutaneous balloon dilatation using cross sectional Doppler echocardiography. RESULTS--The procedure was technically successful in all patients. The mean (SD) echocardiographic value of the mitral valve area increased from 0.7 (0.1) to 1.4 (0.2) cm2 with a concomitant reduction in pulmonary artery systolic pressure (Doppler) from 81 (17) to 50 (7) mm Hg. There was a significant clinical improvement in all patients. The mean (range) fluoroscopy time for the procedure was 6.9 (1.7-14.1) min. During follow up (mean 10 months) nine patients were in New York Heart Association (NYHA) functional class I, one was in class II, one under NYHA elective mitral valve replacement, and one, who refused elective surgery, died suddenly at home. CONCLUSION--Percutaneous balloon dilatation of the mitral valve can be performed as a life saving procedure in critically ill patients with mitral stenosis, as even a modest increase in valve area in these patients produces gratifying clinical improvement.     

Percutaneous balloon mitral valvuloplasty using the Inoue balloon: analysis of echocardiographic and other variables related to immediate outcome

To determine whether the mitral valve morphology influences the results of percutaneous balloon mitral valvuloplasty for mitral stenosis, two-dimensional echocardiography was performed before valvuloplasty in 126 patients (mean age 25.5+/-9.4 years) and in 30 normal controls. The 2D echocardiographic features of mitral valve leaflets: thickness, length and motion; diastolic mitral valvular excursion; chordal length; mitral annular diameter; subvalvular distance ratio; distance between mid mitral annulus to left ventricular apex, base and tip of papillary muscle and effective balloon dilating area, effective balloon dilating area/body surface area and effective balloon dilating diameter/mitral annular diameter were then correlated to the immediate post-valvuloplasty mitral valve area. For the total patients population, post-valvuloplasty valve area increased from 0.67+/-0.17 to 2.1+/-0.86 cm2 (P<0.0001), mean transmitral diastolic gradient decreased from 24.5+/-9.0 to 6.0+/-3.0 mm Hg (P<0.0001), mean left atrial pressure decreased from 29.7+/-6.2 to 12.7+/-4.8 mm Hg (P<0.0001), mean pulmonary artery pressure decreased from 44.8+/-14.2 to 25.4+/-9.5 mm Hg (P<0.0001) and cardiac index increased from 2.7+/-0.38 to 3.1+/-0.55 l/min/m2 (P<0.0001). The patients were divided into three groups on the basis of post-valvuloplasty mitral valve area. Group I had valve area <1.5 cm2, group II had valve area from 1.5 to 1.9 cm2 and group III had valve area > or =2.0 cm2. On comparison, no statistically significant difference was found in any of the echocardiographic variables in the three groups. On univariate, multivariate, multiple regression and discriminate function analysis, none of the variables were found to have significant influence on immediate result of valvuloplasty. There was no significant difference in the incidence of mitral regurgitation in any of the three groups. We conclude that the extent of mitral valvular and subvalvular deformity do not have a significant effect on the immediate outcome of mitral valvuloplasty using the Inoue balloon and it can be successfully performed in patients with severe subvalvular fibrosis. Unique balloon geometry and stepwise balloon sizing may explain these acceptable immediate results in severely deformed valves.     

Pulmonary venous flow dynamics before and after balloon mitral valvuloplasty as determined by transesophageal Doppler echocardiography.

The pattern of left atrial filling was studied in 14 patients with severe mitral stenosis in sinus rhythm before and immediately after successful balloon mitral valvuloplasty by transesophageal pulsed Doppler echocardiography of the left superior pulmonary vein. Mean mitral valve orifice area increased from 0.8 +/- 0.1 to 2.2 +/- 0.3 cm2 (p less than 0.0001), and left atrial mean pressure decreased from 30 +/- 5 to 12 +/- 4 mm Hg (p less than 0.0001) after the procedure. After balloon mitral valvuloplasty, significant increases in peak systolic pulmonary velocity (35 +/- 16 to 44 +/- 10 cm/s; p less than 0.01), systolic flow velocity time integral (3.3 +/- 1.5 to 5.9 +/- 2.0 cm; p less than 0.001) and the ratio of systolic/diastolic pulmonary venous flow velocity time integrals (0.8 +/- 0.4 to 1.4 +/- 0.5; p less than 0.001) were observed. An acute increase in mitral valve orifice area caused no significant changes in peak diastolic forward flow velocity (40 +/- 7 to 41 +/- 9 cm/s; p = not significant [NS]), diastolic forward flow velocity time integral (4.3 +/- 1.7 to 4.6 +/- 1.8 cm; p = NS) and atrial flow reversal velocity (30 +/- 3 to 35 +/- 3 cm/s; p = NS) compared with at baseline. The results suggest that in patients with severe mitral stenosis and sinus rhythm, left atrial filling is biphasic with a diastolic preponderance, and successful mitral valvuloplasty is associated with an immediate increase in pulmonary venous systolic forward flow.     

Emergency mitral valve replacement for traumatic mitral insufficiency following balloon mitral valvotomy: an early haemodynamic study

Acute severe mitral insufficiency may occur during percutaneous transvenous balloon mitarl valvotomy. Urgent surgical intervention in the form of mitral valve repair or replacement may be necessary in these patients. The haemodynamic measurements at various stages in these patients were obtained and compared with those of patients undergoing elective mitral valve replacement for chronic mitral regurgitation. Between September 1995 and December 1947, urgent mitral valve replacement was performed in 14 patients out of a total of 1688 patients who underwent balloon mitral valvotomy. Haemodynamic measurements could be obtained in 7 of these patients and they constituted group I. Eight other patients undergoing elective mitral valve replacement during the same period for chronic mitral regurgitation constituted group II. Standard haemodynamic measurements were obtained at the following stages: (1) Baseline- 20-30 min after endotracheal intubation; (2) stage 1- 20-30 min after termination of the cardiopulmonary bypass: (3) stage 2- four hours after the patient was transferred to ICU and (4) stage 3-30 min after extubation. All the patients were suffering from severe pulmonary hypertension. However, the indices of pulmonary artery hypertension such as mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance as well as right ventricular systolic and end-diastolic pressures did not decrease after surgery in group I. In contrast, in group II, there was significant decrease in mean pulmonary artery pressure (p<0.05), pulmonary capillary wedge pressure (p<0.05), right ventricular systolic (p<0.001) and end-diastolic pressures (p<0.05) at stage 1. These changes persisted throughout the study period. Pulmonary vascular resistance showed a decreasing trend, but attained statistical significance at stage 1 only. Two patients died; one of intractable cardiac failure and another from septicaemia and multiple organ failure in group I, but there were no deaths in group II. Reactive pulmonary hypertension secondary to acute mitral regurgitation may not recover immediately following mitral valve replacement and may be responsible for poor outcome in these patients.     

Long-Term outcome of mitral balloon valvotomy in pregnant women

BACKGROUND AND AIM OF THE STUDY: The study aim was to examine the long-term outcome (nine years) of mitral balloon valvotomy in pregnant patients with severe mitral stenosis. METHODS: Twenty-three patients with severe, symptomatic (NYHA class III/IV) mitral stenosis underwent mitral balloon valvotomy using an Inoue balloon technique during the second trimester of their pregnancy; mean follow up in 19 patients was 5.1 +/- 2.8 years (range: 1 to 9 years). RESULTS: The procedure was successful in all patients. Immediately after valvotomy, the Doppler-derived mitral valve area increased from 0.90 +/- 0.18 to 1.97 +/- 0.36 cm2 (p <0.0001), and the transmitral mean gradient decreased from 15.7 +/- 4.7 to 5.5 +/- 1.6 mmHg (p <0.0001). Four patients had mild worsening of mitral regurgitation, and six developed insignificant interatrial communication immediately after valvotomy. There was no other morbidity or mortality. Patients showed a significant improvement in mean NYHA class, from 3.0 +/- 0.1 to 1.0 +/- 0.02 (p <0.001). Twenty-two patients had normal deliveries; one cesarean section in week 36 resulted in stillbirth. No developmental abnormalities were seen in the babies. At long-term follow up of mothers, the mitral valve area was 1.8 +/- 0.52 cm2; restenosis developed in three patients (16%). One baby died at one week from sudden infant death syndrome, and one at eight months, from pneumonia. All other children showed normal growth, development and speech for their age. CONCLUSION: Mitral balloon valvotomy using the Inoue balloon technique can provide satisfactory immediate relief and long-term outcome in pregnant patients with severe mitral stenosis.     

Prevalence and fate of severe pulmonary hypertension in 559 consecutive patients with severe rheumatic mitral stenosis undergoing mitral balloon valvotomy

BACKGROUND AND AIM OF THE STUDY: The prevalence of severe pulmonary hypertension (PH) in patients with severe mitral stenosis (MS) remains unknown, and the long-term effect of mitral balloon valvotomy (MBV) in large numbers of these patients is not well characterized. METHODS: Details from the prospective MBV database at the authors' institution relating to 559 consecutive patients who had successful MBV were analyzed. Patients were allocated to three groups on the basis of their pulmonary artery systolic pressure (PASP) at cardiac catheterization immediately before MBV: group A (n = 345) had PASP <50 mmHg; group B (n = 183) had PASP 50-79 mmHg; and group C (n = 31) had PASP > or =80 mmHg. Patients were evaluated clinically and echocardiographically at six months after MBV, and annually thereafter for up to 13 years. RESULTS: No mortality was encountered after MBV. Immediately after MBV, the mean PASP was 38.5+/-6.8 mmHg in group A (mild PH), 59.0+/-7.7 mmHg in group B (moderately severe PH), and 97.8+/-17.0 mmHg in group C (severe PH). At follow up (ca. 4 years), Doppler-monitored PASP fell to normal, and was similar in groups A, B and C (29+/-8, 31+/-9, and 29+/-5 mmHg, respectively; p = NS). CONCLUSION: MBV was shown to be safe and effective in treating patients with MS and severe PH. The latter condition regressed to normal levels over 6-12 months after successful MBV.     

Balloon dilation of mitral stenosis in adult patients: postmortem and percutaneous mitral valvuloplasty studies

Preliminary reports have documented the utility of percutaneous balloon valvuloplasty of the mitral valve in adult patients with mitral stenosis, but the mechanism of successful valve dilation and the effect of mitral valvuloplasty on cardiac performance have not been studied in detail. Accordingly, mitral valvuloplasty was performed in five postmortem specimens and in 18 adult patients with rheumatic mitral stenosis, using either one (25 mm) or two (18 and 20 mm) dilation balloons. Postmortem balloon dilation resulted in increased valve orifice area in all five postmortem specimens, secondary to separation of fused commissures and fracture of nodular calcium within the mitral leaflets. In no case did balloon dilation result in tearing of valve leaflets, disruption of the mitral ring or liberation of potentially embolic debris. Percutaneous mitral valvuloplasty in 18 patients with severe mitral stenosis (including 9 with a heavily calcified valve) resulted in an increase in cardiac output (4.3 +/- 1.1 to 5.1 +/- 1.5 liters/min, p less than 0.01) and mitral valve area (0.9 +/- 0.2 to 1.6 +/- 0.4 cm2, p less than 0.0001), and a decrease in mean mitral pressure gradient (15 +/- 5 to 9 +/- 4 mm Hg, p less than 0.0001), pulmonary capillary wedge pressure (23 +/- 7 to 18 +/- 7 mm Hg, p less than 0.0001) and mean pulmonary artery pressure (36 +/- 12 to 33 +/- 12 mm Hg, p less than 0.01). Left ventriculography before and after valvuloplasty in 14 of the 18 patients showed a mild (less than or equal to 1+) increase in mitral regurgitation in five patients and no change in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immediate results in percutaneous mitral valvuloplasty with the Nucleus balloon

We present the immediate results of mitral valvuloplasty in 10 patients using Nucleus balloon. Several publications show highly successful results obtained with the Inoue balloon and double balloon technique. There are no publications of Nucleus balloon. We consider that this device could offer several advantages according to its physical and technical characteristics. We performed the procedure in 10 female patients, with severe mitral valve stenosis, with an average age of 44.8 years (23-70) and an average Wilkins score of 7.5 (6-9), using a combined technique. The increase in mitral valve area with Gorlin equation was 1.03 +/- .13 to 2.6 +/- .67 cm2, the decrease in transmitral gradient from 15 +/- 4.1 to 3.42 +/- 2.6 mm Hg, and decrease in systolic pulmonary pressure from 54.1 +/- 18.8 to 24.9 +/- 5.1 mm Hg. One patient developed grade I mitral insufficiency after the procedure, and another non significant interatrial shunt. CONCLUSIONS: Good results are obtained with this balloon, the valvuloplasty technique is more simple than with double balloon, it is much cheaper than Inoue balloon and we consider it could be useful in moderately calcified valves.     

Assessment of mitral valvar stenosis by echocardiography: utility of various methods before and after mitral valvotomy.

Cross-sectional and Doppler echocardiography are currently the most important non-invasive tests for the evaluation of mitral stenosis. Recent experience has, however, shown that parameters that are reliable before mitral valvotomy may not be valid after the procedure. We have studied the validity of estimation of the area of the mitral valve by echo-planimetry, by Doppler pressure half time and the transmitral end-diastolic pressure gradient calculated by continuous wave Doppler in 100 patients (aged 10-30 years) before and after balloon mitral valvoplasty (n = 70) or surgical closed mitral valvotomy (n = 30). These patients underwent cardiac catheterisation and echocardiographic studies before, immediately after and 8-12 (9.3 +/- 2.2) weeks following balloon valvoplasty or closed valvotomy. The area as estimated echocardiographically correlated well with that obtained by the Gorlin formula before (r = 0.80), but not immediately after (r = 0.67) or on follow up after mitral valvotomy. There was good correlation between Doppler pressure half time and the area as estimated by the Gorlin formula before (r = 0.89) and on follow up after valvotomy (r = 0.82), but the correlation was not as good in the immediate period after valvotomy (r = 0.60). The end-diastolic pressure gradients obtained by Doppler examination and at cardiac catheterisation correlated well with each other before (r = 0.94), immediately after valvotomy (r = 0.92) and on follow up (r = 0.94). Hence, the reliability of estimation of the area of the mitral valve by echo-planimetry and by Doppler pressure half time varies according to the time at which the examination is performed following commissurotomy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Simultaneous echocardiographic and catheterisation gradients and mitral valve area during balloon mitral valvuloplasty.

This study was aimed at estimating mean transmitral gradients by simultaneous Doppler echocardiography and cardiac catheterisation and determining mitral valve area by pressure half time, Gorlin's formula and two-dimensional echocardiography so as to assess the relative accuracy of these methods before and after balloon mitral valvuloplasty in patients with rheumatic mitral stenosis. Left atrium-left ventricular, pulmonary artery wedge-left ventricular and echo gradients were simultaneously recorded in 18 patients undergoing balloon mitral valvuloplasty. Mitral valve area was estimated by pressure half time, Gorlin's equation and two-dimensional echocardiography. The correlation between left atrium-left ventricular and echo mean gradient before balloon mitral valvuloplasty was 0.96 (p < 0.03). Between pulmonary artery wedge-left ventricular and echo mean gradient, it was 0.95 (p < 0.04). The correlations between left atrium-left ventricular and pulmonary artery wedge-left ventricular mean gradient were also good. After balloon mitral valvuloplasty, similar good correlations were seen. On subgrouping the patients into those with high and low pulmonary artery pressure, good correlation persisted both before and after balloon mitral valvuloplasty. Mitral valve area by all the methods were similar before balloon mitral valvuloplasty. After balloon mitral valvuloplasty, mitral valve area by pressure half time was the least and by two-dimensional echocardiography, the maximum. All the three methods are equally accurate in estimating transmitral gradients and mitral valve area in mitral stenosis before balloon mitral valvuloplasty. Two-dimensional echocardiography is the best to estimate mitral valve area after balloon mitral valvuloplasty. Echocardiography can replace haemodynamic measurement of gradients and mitral valve area before and after balloon mitral valvuloplasty. But pressure half time is not recommended for measuring mitral valve area immediately after balloon mitral valvuloplasty where two-dimensional echocardiography mitral valve area is to be employed.