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European Heart Journal 1992 13(4):496-502;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Residual atrial septal defects following balloon mitral valvuloplasty using different techniques

A transthoracic and transoesophageal echocardiography study demonstrating an advantage of the Inoue balloon

M. R. THOMAS, M. J. MONAGHAN, J. M. METCALFE and D. E. JEWITT

Department of Cardiology, King's College Hospital Denmark Hill, London SE5 9RS, U.K.

Received 7 January 1991; revised 9 May 1991; .

Correspondence Dr D. E. Jewitt. Director of Cardiology, Department of Cardiology, King's College Hospital, Denmark Hill London SE5 9RS. U.K.

Abstract

The incidence and severity of atrial sepial defects following balloon mitral valvuloplasty have been assessed using transthoracic and transoesophageal echocardiography in 20 patients 3–36 months following the procedure.

In eight patients (group A) the atrial septum was dilated with an 8mm Olbert balloon and either a double or bifoil balloon used to dilate the mitral valve. In 12 patients (group B) the Inoue balloon, with a slimmer deflated profile, was used following dilatation of the interatrial septum with a 14 French vessel dilator.

In group A, using transthoracic echo cardiography, one a trial septal defect was imaged and transatrial flow detected by colour flow Doppler in five patients. in seven of the eight patients transoesophageal echocardiographv clearly imaged an atrial septal defect and left-to-right shunting was demonstrated by colour flow Doppler. Valsalva contrast studies revealed residual transatrial flow in all eight patients. The mean width of the colour flow jet was 5.8 mm.

In group B patients, using transihoracic echocardiography, only one patient had evidence of residual transatrial flow (demonstrated by Valsalva contrast). Using transoesophageal echocardiography Valsalva contrast studies, transa trial flow was seen in 11 of the 12 patients. However, no defects were imaged and colour flow Doppler indicated left-to-right shunting in only two patients. The mean width of the colour flow jet was 1.5 mm.

Transoesophageal echocardiography with colour flow Doppler and Valsava contrast studies therefore provides a sensitive method for the detection of residual atrial septal defects following balloon mitral valvuloplasty. Transatrial flow persists in the majority of these patients. With the use of the inoue balloon system this is minimal, but when the double or bifoil balloon systems are used defects with left to right shunting are frequently imaged.

Key Words: Mitral valvuloplasty • atrial septal defects


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