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European Heart Journal 1991 12(Supplement B):99-108; doi:10.1093/eurheartj/12.suppl_B.99
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Percutaneous transvenous mitral commissurotomy using the Inoue balloon

K. Inoue

Department of Cardiovascular Surgery, Takeda Hospital Kyoto, Japan

Correspondence: Correspondence: Kanji Inoue, MD, 98-13 Miyazaki-Cho, Simogamo, Sakyo-Ku, Kyoto, 606, Japan.

The Inoue balloon catheter is unique in function as well ar shape, and can be especially adapted for each patient to ensure a high success rate and low morbidrty during percutaneous traansvenous mitral commissurotomy (PTMC). Before transseptal puncture, right atrial angiography is performed to image the proper point of puncture to avoid not only accidental perforation but also the difficulty of balloon insertion into the mitral orifice. There are two main techniques for inserting the balloon into the mitral onfice. One is a direct method, and the other is loop formation in the left atrium. Balloon selection is basically standardized by patient height; 30mm for a height of>180cm, 28 for>160, 26 for>147, 24 for<147. However, it should be smaller in valves with severe pathological changes, to prevent mitral regurgitation especially in valves with a mix of strong and weak echoes in the leaflets, combined with strong echo in the commissures shown on 2-dimenswnal echo-cardwgraphy. For a patient at an advanced age, a smaller balloon should be chosen. A stepwise dilatation technique is effective for preventing the creation of severe mitral regurgitation. Doppler echo-cardiography should be used to decide whether further dilatation is necessary. This will estimate resultant mitral regurgitation, increased mitral valve area and degree of commissure separation.

The disappearance of the balloon waist under fluoroscopy is also important in decision making. PTMC is a treatment of choice for mitral stenosis except for fresh mural thrombus and combined severe mitral regurgitation.

Key Words: Right atrial angiography • stepwise dilatation


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