Balloon mitral valvotomy by using the twin‐at catheter: Immediate results and complications in 110 patients

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Abstract
Balloon mitral valvotomy, using a new Twin AT catheter (two balloons attached side by side over one shaft), was performed in 110 consecutive cases. The age of the patients ranged from 19–78 yr (mean 46 ± 15). From a total of 94 females and 16 males, 23 of the patients (22%) had mitral valve calcification, 47 patients (46%) had atrial fibrillation, and 39 patients (37%) had mitral regurgitation (< +2). Twenty patients (18%) presented with restenosis following surgical commissurotomy. Total catheterization time was 101 ± 26 min and the duration of the valvotomy procedure was 37 ± 21 min in these cases. For the entire population, there was a significant reduction in mitral valve gradient (15 2 6 to 4.8 ± 2.6 mmHg, p < .001), an increase in mitral valve area (MVA) (1.1 ± 0.3 to 2.35 ± 0.7 cm2 ,p < .001), and a decrease in mean pulmonary arterial pressure (31 ± 12 to 26 ± 11, p <.002) after the balloon mitral valvotomy. Sixteen patients (1 4%) developed significant left to right shunt, and in 22 patients (20%) mitral regurgitation increased moderately but without resulting in emergency valve replacement. There was one incidence of embolic episode and one pericardial tamponade. Adequate hemodynamic results (MVA > 1.5 cm2 and % increase in MVA ≥ 50%) without major complications were obtained in 99 cases. In 9 patients with severely diseased valve (2 previous commissurotomy, one restenosis after balloon valvotomy), or small left ventricular cavity, insufficient results were obtained by the Twin‐AT catheter. The Twin‐AT balloon catheter was exchanged for larger 2 balloons combinations in 5 patients and lnoue catheter in 4, and significant improvement in MVA was obtained in 5 cases. Thus, BMV can be safely and effectively performed in most cases with this new Twin‐AT catheter, thereby saving time and cost.