Copyright © 1993 by the European Society of Cardiology.
© 1993 The Europen Society of Cardiology
Balloon mitral valvotomy with a single catheter: a comparison between bifoil/trefoil and the Inoue balloon
Cardiology Department, University of Natal/Wentworth Hospital Durban, South Africa
Received 1 December 1992; revised 18 March 1993; .
Correspondence: Dr J. J. Patel, Cardiology Department, Wentworth Hospital, Private Bag JACOBS, 4026 South Africa
Abstract
Results of percutaneous mitral valvotomy were compared in two groups undergoing the procedure at our institution. Group I: 100 patients having had percutaneous valvotomy with the Schneider–Medintag bifoil (2 x 19 mm) or trefoil (3 x 15 mm or 3 x 12 mm) catheters, and group II: 150 patients in whom the procedure was performed with the Inoue balloon (24–30 mm). Baseline clinical (age, gender, NYHA class and echo score) and haemodynamic variables were similar in both groups.
Haemodynamic improvement occurred in both groups. Although the reduction in left atrial pressure did not differ significantly between the two groups, the increase in mitral valve area was significantly (P<0.001) higher for group I (0.8±0.2 to 1.9±0.7 and 0.8±0.3 to 1.6±0.3 cm2 respectively for mitral area, and 22±6 to 13±5 and 21±6 to 13±5 mmHg respectively for mean left a trial pressure). The increase in cardiac output was statistically significant in group I (3.2±0.7 to 4.0±0.91. min–1, P<0.05) but not in group II (3.5±2.0 to 3.7±0.91. min–1, ns).
Inter-atrial shunting immediately after valvotomy was recorded in 19% of group I patients compared with 6% in group II (P<0.01). The overall incidence of significant mitral regurgitation (3+ or 4+) was similar in both groups (5% and 4% respectively). However, when the stepwise dilatation technique was employed in group II, the incidence had dropped to 2.1%.
The total procedure time was significantly lower in group II (80±13 vs 102±10 min in group I P<0.01), and the technical success rate was 96% in group Iand 100% in group II. Four patients from group I, in whom there was technical dfficulty in positioning the balloon across the mitral valve, had a successful outcome with the Inoue balloon when the procedure was repeated.
It is concluded that the Inoue and bifoil/trefoil balloon produce equivalent haemodynamics, but the Inoue technique is simpler and takes less time to perform. The larger increase in cardiac output after valvotomy and hence the larger mitral valve area in the bifoil/trefoil group is probably the result of the significantly higher incidence of left to right atrial shunting in this group.
Key Words: Mitral stenosis • percutaneous mitral valvotomy • Inoue balloon valvotomy • bifoil/trefoil balloon valvotomy