INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Ahmet Anıl Başkurt

Bakırçay University, Faculty of Medicine, Çiğli Research and Training Hospital, Department of Cardiology, İzmir, Türkiye

Başkurt AA. Percutaneous Balloon Mitral Valvuloplasty. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.95-103.

ABSTRACT

Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a minimally invasive treatment for patients with severe mitral stenosis, especially with rheumatic mitral stenosis. PBMV offers an alternative to surgical interventions such as valve replacement in patients with suitable valve anatomy or not candidate for open surgery. PBMV improves hemodynamic and clinical outcomes reason by decreasing mean mitral gradients and increasing mitral valve area. Echocardiographic assessment such as mitral valve area, mean mitral gradient and Wilkins score is essential for evaluating patient suitability for the PBMV. Most important contraindications are left atrial thrombus, more than mild mitral regurgitation, and a high Wilkins score (>8).

The procedure involves several steps, including transseptal puncture, inflation of the balloon. Transesophageal echocardiography (TOE) is particularly valuable because provides intraoperative real-time imaging and after dilatation, evaluations confirm procedural success and identify complications such as mitral regurgitation or pericardial effussion.

Proper preprocedural preparation including echocardiographic evaluation, anticoagulation management and anesthesia is important. Operator expertise and a multidisciplinary team approach increase process safety and success. PBMV remains a valuable treatment for symptomatic severe mitral stenosis, providing symptom relief and improved quality of life, especially in patients who are high surgical risk or prefer minimally invasive treatments.

Keywords: Balloon valvuloplasty; Mitral stenosis; Percutaneous intervention; Rheumatic mitral stenosis

Referanslar

  1. Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984;87(3):394-402. [Crossref]  [PubMed]
  2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP. 3rd, Fleisher, L. A. et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 135(25), e1159-e1195. [Crossref]  [PubMed]
  3. Palacios IF. Percutaneous Mitral Balloon Valvuloplasty: Worldwide Trends. J Am Heart Assoc. 2019;8(13):e012898. [Crossref]  [PubMed]  [PMC]
  4. Tuzcu EM, Block PC, Griffin BP, Newell JB, Palacios IF. Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 years and older. Circulation. 1992;85(3):963-971. [Crossref]  [PubMed]
  5. Turi ZG. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. Struct Heart. 2022;6(5):100087. Published 2022 Sep 21. [Crossref]  [PubMed]  [PMC]
  6. Chen CR, Cheng TO, Chen JY, Zhou YL, Mei J, Ma TZ. Long-term results of percutaneous mitral valvuloplasty with the Inoue balloon catheter. Am J Cardiol. 1992;70(18):1445-1448. [Crossref]  [PubMed]
  7. Meneguz-Moreno, R. A., Costa, J. R., Jr, Gomes, N. L., Braga, S. L. N., Ramos, A. I. O., Meneghelo, Z. et al. Very Long Term Follow-Up After Percutaneous Balloon Mitral Valvuloplasty. JACC. Cardiovascular interventions. 2018;11(19),1945-1952. [Crossref]  [PubMed]
  8. Fawzy ME. Mitral balloon valvuloplasty. Journal of the Saudi Heart Association. 2010;22(3):125-132. [Crossref]  [PubMed]  [PMC]
  9. Chichareon P, Nilmoje T, Suwanugsorn S, et al. Procedural success and outcomes after percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis with moderate mitral regurgitation: a retrospective cohort study. Cardiovasc Diagn Ther. 2022;12(5):552-562. [Crossref]  [PubMed]  [PMC]
  10. Reyes VP, Raju BS, Wynne J, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Engl J Med. 1994;331(15):961-967. [Crossref]  [PubMed]
  11. Farrag HMA, Setouhi AM, El-Mokadem MO, et al. Additive value of 3D-echo in prediction of immediate outcome after percutaneous balloon mitral valvuloplasty. Egypt Heart J. 2019;71(1):19. [Crossref]  [PubMed]  [PMC]
  12. Mayes CE, Cigarroa JE, Lange RA, Hillis LD. Percutaneous mitral balloon valvuloplasty. Clin Cardiol. 1999;22(8):501-503. [Crossref]  [PubMed]  [PMC]
  13. Bonow RO, O'Gara PT, Adams DH, et al. 2019 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Mitral Valve Intervention: A Joint Report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and The Society of Thoracic Surgeons [published correction appears in J Am Coll Cardiol. 2020 Jul 7;76(1):130. [Crossref]  [PubMed]
  14. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease [published correction appears in Eur Heart J. 2022 Jun 1;43(21):2022. [Crossref]  [PubMed]
  15. Inoue K. Percutaneous transvenous mitral commissurotomy using the Inoue balloon. Eur Heart J. 1991;12 Suppl B:99-108. [Crossref]  [PubMed]
  16. Nobuyoshi M, Arita T, Shirai S, et al. Percutaneous balloon mitral valvuloplasty: a review. Circulation. 2009;119(8):e211-e219. [Crossref]
  17. Chichareon P, Nilmoje T, Suwanugsorn S, et al. Procedural success and outcomes after percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis with moderate mitral regurgitation: a retrospective cohort study. Cardiovasc Diagn Ther. 2022;12(5):552-562. [Crossref]  [PubMed]  [PMC]
  18. Saejueng B, Tansuphaswadikul S, Hengrussamee K, Kehasukcharoen W, Assavahanrit J, Kanoksin A. Experience of percutaneous mechanical mitral commissurotomy using metallic commissurotome in patients with mitral stenosis at chest disease institute. J Med Assoc Thai. 2008;91(6):828-835. [PubMed]
  19. Alnasser SM, Moey M, Ali N, et al. Percutaneous balloon mitral valvuloplasty with shockwave lithotripsy for the treatment of calcific mitral valve stenosis. Catheter Cardiovasc Interv. 2024;104(2):356-364. [Crossref]  [PubMed]