Percutaneous Mitral Balloon Valvuloplasty for Patients with Rheumatic Mitral Stenosis

Immediate and Long-Term Follow-up Results
  • Igor F. Palacios
Part of the Contemporary Cardiology book series (CONCARD)


Since its introduction in 1984 by Inoue et al. (1), percutaneous mitral balloon commissurotomy or valvotomy (PMV) has been used successfully as an alternative to open or closed surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis (2–20). PMV produces good immediate hemodynamic outcome, low complication rates, and clinical improvement in the majority of patients with mitral stenosis (2–20). PMV is safe and effective, and it provides sustained clinical and hemodynamic improvement in patients with rheumatic mitral stenosis. The immediate and long-term results appear to be similar to those of surgical mitral commisssurotomy (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20). Today, PMV is the preferred form of therapy for relief of mitral stenosis for a selected group of patients with symptomatic mitral stenosis.


Mitral Valve Mitral Regurgitation Mitral Stenosis Mitral Valve Area Balloon Valvuloplasty 
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  1. 1.
    Inoue K, Owaki T, Nakamura T, et al. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg 1984;87:394–402.PubMedGoogle Scholar
  2. 2.
    Lock JE, Kalilullah M, Shrivastava S, et al. Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med 1985;313:1515–1518.PubMedCrossRefGoogle Scholar
  3. 3.
    Palacios I, Block PC, Brandi S, et al. Percutaneous balloon valvotomy for patients with severe mitral stenosis. Circulation 1987;75:778–784.PubMedGoogle Scholar
  4. 4.
    Al Zaibag M, Ribeiro PA, Al Kassab SA, Al Fagig MR. Percutaneous double balloon mitral valvotomy for rheumatic mitral stenosis. Lancet 1986;1:757–761.PubMedGoogle Scholar
  5. 5.
    Vahanian A, Michel PL, Cormier B, et al. Results of percutaneous mitral commissurotomy in 200 patients. Am J Cardiol 1989;63:847–852.PubMedCrossRefGoogle Scholar
  6. 6.
    Mc Kay RG, Lock JE, Safian RD, et al. Balloon dilatation of mitral stenosis in adults patients: postmortem and percutaneous mitral valvuloplasty studies. J Am Coll Cardiol 1987;9:723–731.CrossRefGoogle Scholar
  7. 7.
    Mc Kay CR, Kawanishi DT, Rahimtoola SH. Catheter balloon valvuloplasty of the mitral valve in adults using a double balloon technique. Early hemodynamic results. JAMA 1987;257:1753–1761.CrossRefGoogle Scholar
  8. 8.
    Abascal VM, O’Shea JP, Wilkins GT, et al. Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation 1990;82:448–456.PubMedGoogle Scholar
  9. 9.
    Herrman HC, Wilkins GT, Abascal VM, et al. Percutaneous balloon mitral valvotomy for patients with mitral stenosis: analysis of factors influencing early results. J Thorac Cardiovasc Surg 1988;96:33–38.Google Scholar
  10. 10.
    Rediker DE, Block PC, Abascal VM, Palacios IF. Mitral balloon valvuloplasty for mitral restenosis after surgical commissurotomy. J Am Coll Cardiol 1988;2:252–256.Google Scholar
  11. 11.
    Palacios IF, Block PC, Wilkins GT, Weyman AE. Follow-up of patients undergoing percutaneous mitral balloon valvotomy: Analysis of factors determining restenosis. Circulation 1989;79:573–579.PubMedGoogle Scholar
  12. 12.
    Abascal VM, Wilkins GT, Choong CY, et al. Echocardiographic evaluation of mitral valve structure and function in patients followed for at least 6 months after percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol 1988;12:606–615.PubMedGoogle Scholar
  13. 13.
    Block PC, Palacios IF, Block EH, et al. Late (two year) follow-up after percutaneous mitral balloon valvotomy. Am J Cardiol 1992;69:537–541.PubMedCrossRefGoogle Scholar
  14. 14.
    Tuzcu EM, Block PC, Griffin BP, et al. Immediate and long term outcome of percutaneous mitral valvotomy in patients 65 years and older. Circulation 1992;85:963–971.PubMedGoogle Scholar
  15. 15.
    Nobuyoshi M, Hamasaki N, Kimura T, et al. Indications, complications, and short term clinical outcome of percutaneous transvenous mitral commissurotomy. Circulation 1989;80:782–792.PubMedGoogle Scholar
  16. 16.
    Chen CR, Cheng TO, Chen JY, et al. Percutaneous mitral valvuloplasty with the Inoue balloon catheter. Am J Cardiol 1992;70:1455–1458.Google Scholar
  17. 17.
    Hung JS, Chern MS, Wu JJ, et al. Short and long term results of catheter balloon percutaneous transvenous mitral commissurotomy. Am J Cardiol 1991;67:854–862.PubMedCrossRefGoogle Scholar
  18. 18.
    Cohen DJ, Kuntz RE, Gordon SPF, et al. Predictors of long-term outcome after percutaneous mitral valvuloplasty. N Engl J Med 1991;327:1329–1335.CrossRefGoogle Scholar
  19. 19.
    Palacios IF, Sanchez PL, Harrell LC, et al. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002;105:1465–1471.PubMedCrossRefGoogle Scholar
  20. 20.
    Iung BL, Garbarz E, Michaud P, et al. Late results of percutaneous mitral commissurotomy in a series of 1024 patients. analysis of late clinical deterioration: frequency, anatomic findings and predictive factors. Circulation 1999;99:3272–3278.PubMedGoogle Scholar
  21. 21.
    Babic UU, Pejcic P, Djurisic Z, et al. Percutaneous transarterial balloon valvuloplasty for mitral valve stenosis. Am J Cardiol 1986;57:1101.PubMedCrossRefGoogle Scholar
  22. 22.
    Stefanides C, Kouroklis C, Stratos C, et al. Percutaneous balloon mitral valvuloplasty by retrograde left atrial catheterization. Am J Cardiol 1990;65:650–654.CrossRefGoogle Scholar
  23. 23.
    Stefanides C, Stratos C, Pitsavos C, et al. Retrograde nontransseptal balloon mitral valvuloplasty. Immediate results and long term follow-up. Circulation 1992;85:1760–1767.Google Scholar
  24. 24.
    Palacios IF, Lock JE, Keane JF, Block PC. Percutaneous transvenous balloon valvotomy in a patient with severe calcific mitral stenosis. J Am Coll Cardiol 1986;7:1416.PubMedGoogle Scholar
  25. 25.
    Cribier A, Eltchaninoff H, Koning R, et al. Percutaneous mechanical mitral commissurotomy with a newly designed metallic valvulotome immediate results of the initial experience in 153 patients. Circulation 1999;99:793–799.PubMedGoogle Scholar
  26. 26.
    Bonhoeffer P, Hausse A, Yonga G, et al. Technique and results of percutaneous mitral valvuloplasty with the multi-track system. J Interv Cardiol 2000;13(4):263–268.CrossRefGoogle Scholar
  27. 27.
    Block PC, Palacios IF, Jacobs M, et al. The mechanism of successful percutaneous mitral valvotomy in humans. Am J Cardiol 1987;59:178.PubMedCrossRefGoogle Scholar
  28. 28.
    Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous mitral valvotomy: An analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988;60:299–308.PubMedCrossRefGoogle Scholar
  29. 29.
    Ruiz CE, Zhang HP, Macaya C, et al. Comparison of Inoue-single balloon versus double balloon techniques for percutaneous mitral valvotomy. Am Heart J 1992;123:942–947.PubMedCrossRefGoogle Scholar
  30. 30.
    Leon MN, Pathan A, Lopez JC, et al. Immediate outcome of Inoue vs. double balloon percutaneous mitral valvotomy: The Massachusetts General Hospital experience. Circulation 1997;96(Suppl I):2224.Google Scholar
  31. 31.
    Abascal VM, Wilkins GT, Choong CY, et al. Mitral regurgitation after percutaneous mitral valvuloplasty in adults: evaluation by pulsed Doppler echocardiography. J Am Coll Cardiol 1988;2:257–263.Google Scholar
  32. 32.
    The National Heart, Lung and Blood Institute Balloon Valvuloplasty Registry. Complications and mortality of percutaneous balloon mitral commissurotomy. Circulation 1992;85:2014–2024.Google Scholar
  33. 33.
    Roth RB, Block PC, Palacios IF. Predictors of increased mitral regurgitation after percutaneous mitral balloon valvotomy. Cathet Cardiovasc Diagn 1990;20:17–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Padial LR, Freitas N, Sagie A, et al. Echocardiography can predict which patients will develop severe mitral regurgitation following percutaneous mitral valvulotomy. J Am Coll Cardiol 1996;27:1225–1331.PubMedCrossRefGoogle Scholar
  35. 35.
    Herrmann HC, Lima JAC, Feldman T, et al. Mechanisms and outcome of severe mitral regurgitation after Inoue balloon valvuloplasty. J Am Coll Cardiol 1993;22:783–789.PubMedGoogle Scholar
  36. 36.
    Casale P, Block PC, O’Shea JP, Palacios IF. Atrial septal defect after percutaneous mitral balloon valvuloplasty: immediate results and follow-up. J Am Coll Cardiol 1990;15:1300–1304.PubMedGoogle Scholar
  37. 37.
    Desideri A, Vanderperren O, Serra A, et al. Long term (9 to 33 months) echocardiographic follow-up after successful percutaneous mitral commissurotomy. Am J Cardiol 1992;69:1602–1606.PubMedCrossRefGoogle Scholar
  38. 38.
    Palacios IF, Tuzcu EM, Newell JB, Block PC. Four year clinical follow-up of patients undergoing percutaneous mitral balloon valvotomy. Circulation 1990;(Suppl III):545.Google Scholar
  39. 39.
    Babic UU, Grujicic S, Popovic Z, et al. Percutaneous transarterial balloon dilatation of the mitral valve. Five year experience. Br Heart J 1992;67:185–189.PubMedCrossRefGoogle Scholar
  40. 40.
    The National Heart, Lung and Blood Institute Balloon Valvuloplasty Registry Participants. Multicenter experience with balloon mitral commissurotomy. NHLBI balloon valvuloplasty resgistry report on immediate and 30 day follow-up results. Circulation 1992;85:448–461.Google Scholar
  41. 41.
    Pan M, Medina A, de Lezo JS, Hernandez E, et al. Factors determinig late success after mitral balloon valvotomy. Am J Cardiol 1993;71:1181–1185.PubMedCrossRefGoogle Scholar
  42. 42.
    Herrmann HC, Kleaveland P, Hill JA, et al. The M-heart percutaneous balloon mitral valvuloplasty registry: initial results and early follow-up. J Am Coll Cardiol 1990;15:1221.PubMedGoogle Scholar
  43. 43.
    Marzo KP, Herrmann HC, Mancini DM. Effect of balloon mitral valvuloplasty on exercise capacity, ventilation, and skeletal muscle oxygenation. J Am Coll Cardiol 1993;21:856.PubMedGoogle Scholar
  44. 44.
    Tuzcu EM, Block PC, Griffin B, et al. Percutaneous mitral balloon valvotomy in patients with calcific mitral stenosis: immediate and long term outcome. J Am Coll Cardiol 1994;23:1604–1609.PubMedGoogle Scholar
  45. 45.
    Post JR, Feldman T, Isner J, Herrmann HC. Inoue balloon mitral valvotomy in patients with severe valvular and subvalvular deformity. J Am Coll Cardiol 1995;25:1129–1136.PubMedCrossRefGoogle Scholar
  46. 46.
    Harken DE, Ellis LB, Ware PF. The surgical treatment of mitral stenosis. I. Valvuloplasty. N Engl J Med 1948;239:801.PubMedCrossRefGoogle Scholar
  47. 47.
    Williams JA, Littmann D, Warren R. Experience with the surgical treatment of mitral stenosis. N Engl J Med 1958;258:623–630.PubMedCrossRefGoogle Scholar
  48. 48.
    Scannell JG, Burke JF, Saidi F, Turner JD. Five-year follow-up study of closed mitral valvotomy. J Thorac Cardiovasc Surg 1960;40:723–730.PubMedGoogle Scholar
  49. 49.
    Medina A, Delezo JS, Hernandez E, et al. Balloon valvuloplasty for mitral restenosis after previous surgery. A comparative study. Am Heart J 1990;120:568–571.PubMedCrossRefGoogle Scholar
  50. 50.
    Davidson CJ, Bashore TM, Mickel M, et al. Balloon mitral commissurotomy after previous surgical commissurotomy. Circulation 1992;86:91–99.PubMedGoogle Scholar
  51. 51.
    Jang IK, Block PC, Newell JB, et al. Percutaneous mitral balloon valvotomy for recurrent mitral stenosis after surgical commissurotomy. Am J. Cardiol 1995;75:601–605.PubMedCrossRefGoogle Scholar
  52. 52.
    Leon M, Harrell L, Mahdi N, et al. Immediate and long term outcome of percutaneous mitral balloon valvotomy in patients with mitral stenosis and atrial fibrillation. J Am Coll Cardiol. 1998;(Supplement).Google Scholar
  53. 53.
    Tarka EA, Blitz LR, Herrmann HC. Hemodynamic effects and long-term outcome of percutaneous balloon valvuloplasty in patients with mitral stenosis and atrial fibrillation. Clin Cardiol 2000;23:673–677.PubMedCrossRefGoogle Scholar
  54. 54.
    Chen MH, Semigran M, Schwammenthal E, et al. Impact of pulmonary resistance on short and long term outcome after percutaneous mitral valvuloplasty. Circulation (submitted for publication).Google Scholar
  55. 55.
    Mahoney PD, Loh E, Blitz LR, Herrmann HC. Hemodynamic effects of inhaled nitric oxide in women with mitral stenosis and pulmonary hypertension. Am J Cardiol 2001:87:188–192.PubMedCrossRefGoogle Scholar
  56. 56.
    Sagie A, Schwammenthal E, Newell JB, et al. Significant tricuspid regurgitation is a marker for adverse outcome in patients undergoing mitral balloon valvotomy. J Am Coll Cardiol. 1994;24:696–702.PubMedGoogle Scholar
  57. 57.
    Lopez-Cuellar JC, Leon MN, Pathan A, et al. Ten-year follow-up of optimal candidates for percutaneous mitral balloon valvuloplasty. Circulation. 1997;96(Supplement I):2225.Google Scholar
  58. 58.
    Petrossian GA, Tuzcu EM, Ziskind AA, et al. Atrial septal occlusion improves the accuracy of mitral valve area determination following percutaneous mitral balloon valvotomy. Cathet Cardiovasc Diagn 1991;22:21–24.PubMedCrossRefGoogle Scholar
  59. 59.
    John S, Bashi VV, Jairaj PS, et al. Closed mitral valvotomy: early results and long term follow up of 3724 patients. Circulation 1983;68:891–896.PubMedGoogle Scholar
  60. 60.
    Ellis LR, Harken DE, Black H. A clinical study of 1,000 consecutive cases of mitral stenosis two to nine years after mitral valvuloplasty. Circulation 1959;19:803.PubMedGoogle Scholar
  61. 61.
    Elis FH, Kirklin JW, Parker RL, et al. Mitral commissurotomy: an overall appraisal of clinical and hemodynamic results. Arch Intern Med 1954;94:774.Google Scholar
  62. 62.
    Hoeksema TD, Wallace RB, Kirklin JW. Closed mitral commissurotomy. Am J Cardiol 1966;17:825–828.CrossRefGoogle Scholar
  63. 63.
    Kirklin JW. Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis. Circulation 1991;83:1450–1451.PubMedGoogle Scholar
  64. 64.
    Higgs LM, Glancy DL, O’Brien KP, et al. Mitral restenosis: an uncommon cause of recurrent symptoms following mitral commissurotomy Am J Cardiol 1970;26:34–37.PubMedCrossRefGoogle Scholar
  65. 65.
    Glover RP, Davila JC, O’Neil TJE, Janton OH. Does mitral stenosis recur after commissurotomy? Circulation 1955;11:14–28.PubMedGoogle Scholar
  66. 66.
    Hickey MSJ, Blackstone EH, Kirklin JW, Dean LS. Outcome probabilities and life history after surgical mitral commissurotomy: Implications for balloon commissurotomy. J Am Coll Cardiol 1991;17:29–42.PubMedGoogle Scholar
  67. 67.
    Scalia D, Rizzoli G, Campanile F, et al. Long-term results of mitral commissurotomy. J Thorac Cardiovasc Surg 1993;105:633–642.PubMedGoogle Scholar
  68. 68.
    Rihal CS, Schaff HV, Frye RL, et al. Long-term follow-up of patients undergoing closed transventricular mitral commissurotomy: a useful surrogate for percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol 1992;20:781–786.PubMedGoogle Scholar
  69. 69.
    Turi ZG, Reyes VP, Raju BS, et al. Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis: a prospective, randomized trial. Circulation 1991;83:1179–1185.PubMedGoogle Scholar
  70. 70.
    Reyes VP, Raju BS, Wynne J, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Eng J Med 1994;331:961–967.CrossRefGoogle Scholar
  71. 71.
    Farhat MB, Ayari M, Maatouk F, et al. Percutaneous balloon verus surgical closed and open mitral commissurotomy: seven year follow-up results of a randomized trial. Circulation 1998;97:245–250.PubMedGoogle Scholar
  72. 72.
    Patel JJ, Sharma D, Mitha AS, et al. Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol 1991;18:1318–1322.PubMedGoogle Scholar
  73. 73.
    Shrivastava S, Mathur A, Dev V, et al. Comparison of immediate hemodynamic response of closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty in rheumatic mitral stenosis. J Thorac Cardiovasc Surg 1992;104:1264–1267.PubMedGoogle Scholar
  74. 74.
    Arora R, Nair M, Kalra GS, Nigam M, Kkhalillulah M. Immediate and long-term results of balloon and surgical closed mitral valvotomy: a randomized comparatve study. Am Heart J 1993;125:1091–1094.PubMedCrossRefGoogle Scholar
  75. 75.
    Palacios IF. Farewell to surgical mitral commissurotomy for many patients. Circulation 1998;97:223–226.PubMedGoogle Scholar
  76. 76.
    Bernal Y, Miralles PJ. Cardiac surgery with cardiopulmonary bypass during pregnancy. Obstet Gynecol Surg 1986;41:1.Google Scholar
  77. 77.
    Vosloo S, Reichart B. The feasibility of closed mitral valvotomy in pregnancy. J Thorac Cardiovasc Surg 1987;93:675.PubMedGoogle Scholar
  78. 78.
    Palacios IF, Block PC, Wilkins GT, et al. Percutaneous mitral balloon valvotomy during pregnancy in patients with severe mitral stenosis. Cathet Cardiovasc Diagn 1988;15:109.PubMedCrossRefGoogle Scholar
  79. 79.
    Mangione JA, Zuliani MF, Del Castillo JM, et al. Percutaneous double balloon mitral valvuloplasty in pregnant women. Am J Cardiol 1989;64:99.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Igor F. Palacios
    • 1
  1. 1.Cardiac Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBoston

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