Retrograde nontransseptal balloon mitral valvuloplasty. Immediate results and long-term follow-up.

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Abstract
BACKGROUND Percutaneous retrograde nontransseptal balloon mitral valvuloplasty is a new technique developed in our institution for opening a stenotic mitral valve. This technique is based on a new, externally steerable cardiac catheter that enters the left atrium retrogradely via the left ventricle. METHODS AND RESULTS The technique was used in 86 consecutive patients (18 men and 68 women; mean age, 51 +/- 11 years). Dilatation of the stenotic mitral valve was achieved in 85 of the 86 patients. After the procedure, mitral valve area increased from 0.92 +/- 0.22 to 2.14 +/- 0.54 cm2 and transmitral gradient decreased from 16 +/- 6 to 5 +/- 2 mm Hg. Major complications, such as cardiac performation, embolic events, or death, were not encountered. Severe mitral regurgitation (greater than 2+) developed in three patients (3.5%). In two patients (2.4%), there was major injury of the femoral artery. The maintenance of the initial improvement was similar to that found in studies that used transseptal techniques. The restenosis rate during the 2-year follow-up was 15.4%. CONCLUSIONS The immediate and long-term findings of this study indicate that retrograde percutaneous nontransseptal balloon mitral valvuloplasty is an effective and safe procedure with an acceptable major complication rate. Moreover, this new technique has the advantage that it does not involve puncture and dilatation of the interatrial septum, although it may occasionally lead to arterial damage. Further studies will show whether it may really be considered as an alternative method or method of choice for percutaneous balloon mitral valvuloplasty.