Gupta Tanush, Barrett Trace, Dauerman Harold L, Lahoud Rony N
Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA.
JACC Case Rep. 2025 Feb 5;30(3):103130. doi: 10.1016/j.jaccas.2024.103130.
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.
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.
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.
使用经典的井上技术对风湿性二尖瓣狭窄（MS）进行经皮球囊二尖瓣成形术（PBMV）在技术上可能具有挑战性，尤其是在解剖结构复杂的情况下。本文描述了一种基于导丝的新型PBMV技术，该技术包括将井上球囊在预先塑形的0.035英寸硬导丝上推进。
这些步骤包括靶向房间隔穿刺、将可操纵鞘管推进至左心房、穿过病变的二尖瓣、在左心室交换为0.035英寸预先塑形的导丝、在导丝上使适当尺寸的井上球囊变细、将球囊推进并定位穿过二尖瓣以及球囊充盈。
除了标准的井上球囊套件中的设备外，该技术确实使用了额外的设备，特别是可操纵鞘管和0.035英寸预先塑形的硬导丝。
由于高收入国家风湿性二尖瓣狭窄的患病率较低，即使是经验丰富的结构性心脏病手术医生对PBMV手术的经验也较少。使用所描述的方法，可以通过导丝以安全、可预测的方式进行PBMV。
