Percutaneous balloon mitral valvuloplasty: Issues involved in comparing techniques

A variety of techniques have been developed for performing percutaneous balloon mitral valvuloplasty. Two approaches, the Inoue catheter and double- balloon technique, have had the widest application. The Inoue procedure is technically simpler, with shorter fluoroscopy and procedure times. Acute hemodynamic results are excellent for both procedures, which result in significant reductions of left atrial pressure, transmitral gradient, and increases in mitral valve area. Although minimal randomized data are available, cumulative data from worldwide observational studies suggest postprocedure mitral valve areas may be slightly higher with the double- balloon technique. However, multicenter registry studies suggest a higher incidence of procedural complications with the double-balloon technique. The relative long-term efficacy, complications, and incidence of repeat mitral valve procedures are unknown and likely will never be resolved without a randomized trial. In summary, both Inoue and double-balloon techniques are suitable for performing percutaneous balloon mitral valvuloplasty. The Inoue catheter has clear advantages in terms of technical ease of operation and likely lower complication rates. The possibility of systematically obtaining slightly larger mitral valve areas with the double-balloon technique cannot be ruled out.