Mitral Balloon Valvuloplasty: State-of-the-Art Paper

Percutaneous mitral balloon valvuloplasty (MBV) was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, MBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis (MS). With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. When the reported complications of MBV are viewed in aggregate, complications occur at approximately the following rates: mortality (0% to 0.5%), cerebral accident (0.5% to 1%), mitral regurgitation (MR) requiring surgery (2% to 3%). These complication rates compare favorably to those reported after surgical commissurotomy. Several randomized trials reported similar hemodynamic results with MBV and surgical commissurotomy. Restenosis after MBV range from 4% to 70% depending on the patient selection, valve morphology and duration of follow up. Restenosis was encountered in 17.5% of the author's series and the 10-year restenosis free survival is 68% and is higher (78%) in patients with favorable mitral morphology. The 10-year event free survival is 80% and is higher (86%) in patients with favorable mitral morphology. The effect of MBV on severe pulmonary hypertension, concomitant severe tricuspid regurgitation, left ventricular function, left atrial size and atrial fibrillation will be addressed in the review. In addition, the application of MBV in specific clinical situations such as children, during pregnancy and for restenosis is discussed.