Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Current Techniques of Mitral CBV
In this technique the dilatation balloon was also introduced transseptally over a long exchange guide wire that had been placed across the atrial septum and mitral valve and then into the left ventricle or out into the descending aorta.
An alternative retrograde technique has also been proposed. The transseptal catheterization is performed as usual, and long guide wires, placed into the femoral artery and aorta, are “snared” and pulled out the femoral vein. The same wire then traverses the femoral artery, the aorta, the left ventricle, the left and right atrium, and the femoral vein. Each dilatation balloon catheter is then placed transarterially, positioned retrograde across the mitral valve, and inflated. This technique avoids the need to advance two large balloon catheters across the interatrial septum, an approach that is associated with residual atrial septal defects in some patients. This transarterial approach using two long dilatation balloons may also cause atrial septal defects and may cause arterial complications. The guide wire position may also be difficult to establish and maintain with this technique. website
Single-balloon techniques have been reported to achieve wide valve opening in children and some adult patients who have small mitral valve annulus sizes; however, several problems may be associated with relatively large-diameter single balloons, including: difficulty passing them into the femoral vein, the femoral artery, and across the interatrial septum (producing large entry holes); inability to apply sufficient lateral force to the mitral valve to open the scarred and fused commissures; and difficulty stabilizing the wider balloon across the mitral valve as it is inflated. Mitral CBV using single balloons therefore may achieve only minimal changes in mitral valve area in some patients. Our current practice is to perform double-balloon mitral CBV in all adult patients.