The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status

Percutaneous balloon mitral valvuloplasty (PBMV), once the most complex of percutaneous cardiac procedures and essentially the first adult structural heart intervention, set the stage for a host of new technologies. Ran-domized studies comparing PBMV to surgery were the first to provide a high-level evidence base in structural heart. The devices used have changed little in 40 years, but the advent of improved imaging and the expertise gained in interventional cardiology has provided some additional procedural safety. However, with the decline in rheumatic heart disease, PBMV is being performed in fewer patients in industrialized nations; in turn, these patients have more comorbidities, less favorable anatomy, and thus a higher rate of procedure-related compli-cations. There remain relatively few experienced operators, and the procedure is distinct enough from the rest of the structural heart intervention world that it has its own steep learning curve. This article reviews the use of PBMV in a variety of clinical settings, the influence of anatomic and physiologic factors on outcomes, the changes in the guidelines, and alternative approaches. PBMV remains the procedure of choice in patients with mitral stenosis with ideal anatomy and a useful tool in patients with less than ideal anatomy who are poor surgical candidates. In the 40 years since its first performance, PBMV has revolutionized the care of mitral stenosis patients in developing countries and remains an important option for suitable patients in industrialized nations. ARF, acute rheumatic fever; DOAC, direct oral anticoagulant; LAA, left atrial appendage; MAC, mitral annular calcification; MR, mitral regurgitation; MS, mitral stenosis; MVD, mitral valve disease; PBMV, percutaneous balloon mitral valvuloplasty; PHT, pulmonary hypertension; RCT, randomized controlled trial; RHD, rheumatic heart disease; SHD, structural heart disease; TAVR, transcatheter aortic valve replacement; TEE, transesophageal echo; TEER, transcatheter edge to edge repair; TTE, transthoracic echocardiogram.