[Long-term results after successful mitral valvuloplasty: comparison of Inoue and double balloon technique]

Abstract

Mitral balloon valvuloplasty is the treatment of choice for severe mitral stenosis in young patients with a minimally calcified and pliable mitral valve. The present study reports the results of the first 65 patients undergoing mitral valvuloplasty in Zurich with the double-balloon or Inoue-balloon technique. Early outcome and late follow-up over 4.1 +/- 2.5 years were evaluated in these patients.

Patients: Percutaneous mitral valvuloplasty was performed in 65 patients (48 females and 12 males, mean age 41 +/- 11 years). The double-balloon technique was used in 25 and the Inoue-balloon technique in 40 patients. Left ventricular pressure as well as pressure gradient and valve area were calculated before and after the intervention. Mitral valvuloplasty was considered to be successful when the valve area was > or = 1.5 cm2 and the pressure gradient < or = 8 mm Hg.

Results: Mitral valvuloplasty was successful in 22 patients of group 1 and 39 patients of group 2. Acute complications were observed in 4 patients (6%), i.e. 1 perforation of the left atrium, 1 perforation of the left ventricle, 1 peripheral embolisation and 1 rupture of the mitral leaflet. Mitral valve area increased from 1.0 to 1.9 cm2 with the double-balloon and from 1.0 to 2.0 cm2 with the Inoue-balloon technique. The pressure gradient over the mitral valve dropped significantly from 11 to 4 mm Hg in group 1 and from 15 to 5 mm Hg in group 2. Left ventricular ejection fraction remained unchanged but left atrial pressure decreased significantly in the first group from 20 to 9 mm Hg and in the second group from 22 to 12 mm Hg. Long-term follow-up over 4.1 years showed a mild (not significant) decrease in valve area from 1.7 to 1.6 cm2 in both groups, with NYHA class unchanged and bicycle exercise capacity increased from 76 to 82%.

Conclusions: Mitral valvuloplasty with either the double-balloon or Inoue-balloon technique provides excellent clinical, echocardiographic and haemodynamic results. The long-term follow-up demonstrated a mild decrease in mitral valve area but clinical symptomatology and physical exercise capacity remained unchanged. From a technical standpoint the Inoue-balloon technique is easier to use and has a lower complication rate (2.5%) compared to the double-balloon technique (12%). Thus, in the last few years the double-balloon technique has been replaced by the Inoue-balloon technique, with a good long-term outcome over the first 4-5 years of follow-up.