Novel Wire-Based Technique for Percutaneous Balloon Mitral Valvuloplasty.

OBJECTIVES

Percutaneous balloon mitral valvuloplasty (PBMV) for rheumatic mitral stenosis (MS) using the classical Inoue technique can be technically challenging, especially in difficult anatomies. This paper describes a novel wire-based technique of PBMV that involves advancement of the Inoue balloon over a preshaped stiff 0.035-inch wire.

KEY STEPS

These include targeted transseptal puncture, advancement of a steerable sheath to the left atrium, crossing the diseased mitral valve, exchanging for a 0.035-inch preshaped wire in the left ventricle, slenderization of the appropriately sized Inoue balloon on the wire, advancement and positioning of the balloon across the mitral valve, and balloon inflation.

POTENTIAL PITFALLS

This technique does use additional equipment, in addition to that in the standard Inoue balloon kit, specifically a steerable sheath and an 0.035-inch preshaped stiff wire.

TAKE-HOME MESSAGES: Due to lower prevalence of rheumatic mitral stenosis in higher-income countries, even high-volume structural operators gain lesser experience with PBMV procedures. PBMV can be performed in a safe, predictable manner over the wire using the described approach.