Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Balloon mitral valvotomy: comparison between antegrade Inoue and retrograde non-transseptal techniques
Department of Cardiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences New Delhi, India
Correspondence: Dr V. K. Bahl, Addl. Professor of Cardiology, All India Institute of Medical Sciences, New Delhi-110029, India
Abstract
AIMS: The results of percutaneous mitral valvotomy performed by the antegrade transseptal method using the Inoue balloon (n=1000; group 1) and by the retrograde non-transseptal technique using a 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. There was a significant increase in mitral valve area estimated by Gorlin's equation (Group 1: from 0·8 ± 0·5 to 2·1 ± 0·8 cm2; Group 2: from 0·8 ± 0·3 to 1·9 ± 0·8 cm2, both P<0·001) and by Doppler echocardiography using the pressure half-time method (Group 1: from 0·9 ± 0·4 to 2·2 ± 0·6 cm2; Group 2: from 0·9 ± 0·3 to 2·0 ± 0·7 cm2, both P<0·001). However, the calculated immediate post-valvotomy mitral valve area was larger with the Inoue technique (2·1 ± 0·8 vs 1·9 ± 0·8 cm2; P<0·02). Results were considered optimal when the mitral valve area increased to 
1·5 cm2, the percentage increase was 
50, and mitral regurgitation was 2/4. Out of the total successful procedures, optimal results were obtained in 95% patients in Group 1 and 94% in Group 2. Incidence of significant mitral regurgitation (grade 3/4) was similar in two groups (Group 1: 4% vs Group 2: 5%, P=ns). A significant left to right atrial shunt (Qp/Qs 1·5:1) in 2·5% and tamponade in 2% of cases occurred exclusively with the Inoue technique, while conduction disturbances, such as transient (<24 h) left bundle branch block (28%) and complete heart block (2%) were noted with the retrograde technique (Group 2). Local complications were significantly higher in Group 2 (3% vs 0·5%, P<0·01). The procedure time with the Inoue technique was shorter than with the retrograde (Group 1: 15 ± 8, range 10 to 35 min; Group 2: 22 ± 14, range 15 to 45 min, P=0·05). Echocardiographic follow-up at 1 year showed no significant difference in mitral valve area between the two groups (Group 1 (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 retrograde non-transseptal technique results in significant immediate haemodynamic and symptomatic improvement. The Inoue technique achieved a larger immediate post-valvotomy mitral valve area, but the difference was not apparent at 1 year follow-up. Incidence of significant mitral regurgitation was similar with both the techniques; however, local complications occurred more frequently with the retrograde technique. Both techniques may complement each other in technically difficult cases.
Key Words: Balloon mitral valvotomy • retrograde non-transseptal balloon mitral valvotomy • Inoue balloon
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