[Percutaneous transvenous mitral commissurotomy (PTMC) by using Inoue-balloon].

Inoue-Balloon was the first one developed for non-surgical mitral commissurotomy. The advantages of Inoue-Balloon are 1) large diameter (30mm-24mm) with low profile (4.5mm), 2) easy balloon placement, 3) non-slip during dilatation, 4) adjustability of diameter, 5) quick inflation and deflation. From 1982 to 1988, PTMC were performed in 512 pts by using Inoue-Balloon. Contra-indication for PTMC are Combined mitral regurgitation of 3/4 or more and fresh thrombus in the left atrium. No patients died during PTMC. Complication included 2 (0.4%) cerebral embolisms, 11 (2%) severe mitral regurgitations. PTMC resulted in increase of mitral valve area from 1.13 +/- 0.02 cm2 to 1.97 +/- 0.04 cm2. The statistic analysis using unpaired t test identified that the increased MVA is significantly larger in pliable valve than in non pliable valve (p less than 0.0001). The increased MVA is also significantly affected by the following conditions; subvalvular lesion (p less than 0.02), previous surgical mitral commissurotomy (0.0007), and atrial fibrillation (p less than 0.001). Incidence of resultant mitral regurgitation is significantly higher in thickened commissure than in non-thickened commissure (p less than 0.005). Similarly, this is also higher in the pre-MVA under 1 cm2 than in those over 1 cm2 (p less than 0.006). No correlation was found between balloon size and the incidence of mitral regurgitation. The optimal sizes of the balloon for the PTMC are 27 or 28 mm in diameter for an average Asian patient, and 28 to 30 mm for the European patients.(ABSTRACT TRUNCATED AT 250 WORDS)