Catheter Balloon Valvuloplasty of the Mitral Valve in Adults Using a Double-Balloon Technique

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Abstract
Catheter balloon valvuloplasty (CBV) using the double-balloon technique was performed on 12 symptomatic patients (mean age, 43 years) with rheumatic mitral valve stenosis. Two dilatation balloons were used in which the diameters approximately equaled the mitral valve anulus diameter as determined. After CBV, the mean mitral valve gradient decreased in all patients (mean ± SD, 16 ± 6 to 5 ± 2 mm Hg), the mean left atrial pressure decreased (29 ± 7 to 16 ± 4 mm Hg), and the cardiac output increased (4.4 ±1.2 to 5.5 ±1.4 L/min). The mitral valve area increased from 1.0 ± 0.3 to 2.4 ± 0.8 cm2. Oximetry demonstrated small left to right shunts of pulmonary to systemic flow ratios of 1.4:1 and 1.3:1 in two patients. Mitral regurgitation did not increase. Gradual decreases in mean pulmonary artery pressures and pulmonary vascular resistance were recorded over the subsequent 24 hours. Our patients left the hospital two days after CBV. The New York Heart Association Functional Class improved in 11 of 12 patients. We conclude that CBV using the double-balloon technique effectively relieves mitral valve obstruction, reduces elevated pulmonary pressures, and reduces symptoms in selected adult patients with symptomatic mitral stenosis. (JAMA1987;257:1753-1761)