Copyright © 1998 by the European Society of Cardiology.
Simplified percutaneous mitral valvuloplasty with the Inoue balloon
Hôpital Universitaire Saint-Jacques, Besançon, France
accepted September 20, 1997
Background
Percutaneous mitral valvuloplasty with the Inoue balloon is conventionally performed with double vascular access: arterial and venous. However, in patients with a good echogenic window it may be performed with venous access only and the procedure monitored by 2D-echocardiography and colour flow mapping. This should result in early ambulation and hospital discharge with reduced arterial complications.
Aims
To compare retrospectively the immediate results of percutaneous mitral valvuloplasty with the Inoue balloon in two groups of patients: Group I: venous access only (no arterial access, n=102) and Group II: conventional double vascular access (arterial and venous access, n=275).
Methods and Results
The baseline characteristics of the two groups were comparable for age, sex, clinical, echo-cardiographic, radiological and haemodynamic variables. The mitral valve area (Group I: 1·1±0·3 to 1·85±0·5cm2vs Group II: 1·05±0·2 to 1·85±0·5cm2, P=ns) and transmitral gradient (Group I: 11±4 to 4·7±2mmHg vs Group II: 12±4 to 4·8±2mmHg, P=ns) before and after mitral valvuloplasty were not statistically different. A good immediate result, defined as mitral valve area >1·5cm2and mean mitral gradient <5mmHg with mitral regurgitation 
2+ at the end of the procedure, was observed in 77% of the cases in the venous-only group and 79% in the double access group (P=ns). The incidence of severe mitral regurgitation (Grade III or IV) was not statistically significant. Procedural duration (71±24min vs 109±26min, P<0·01), fluoroscopic time (12·5±5·5min vs 18·5±6min, P<0·01) and hospital stay (2·8±15 days vs 4·8±2·6 days, P<0·001) were significantly shorter in the venous-only group than in the conventional Inoue series.
Conclusion
Single venous access balloon mitral valvu-loplasty is as equally safe and effective as double vascular access. The additional advantages of single venous access are shorter procedural duration, fluoroscopic time and hospital stay. We recommend that it be performed by an experienced operator (minimum of 100 trans-septal punctures) in patients without major thoracic deformity and a good echogenic window.
Key Words: mitral stenosis • percutaneous mitral valvuloplasty • Inoue's technique • lone venous access
f1 Correspondence: Sanjiv Gupta, Attache Associe, Service de Cardiologie, Hôpital Universitaire Saint-Jaques, 25000 Besançon, France.
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