Comparison of percutaneous transmitral commissurotomy with Inoue balloon technique and metallic commissurotomy: Immediate and short-term follow-up results of a randomized study

• Published in: The American heart journal Vol. 144; no. 6; pp. 1074 - 1080
• Main Authors: Bhat, Anil, Harikrishnan, S., Tharakan, J.M., Titus, T., Kumar, V.K.Ajit, Sivasankaran, S., Bimal, Francis, Krishnamoorthy, K.M.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2002; Elsevier; Elsevier Limited
• Subjects: Adult; Balloon Occlusion; Biological and medical sciences; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Cardiology; Catheterization - instrumentation; Catheterization - methods; Catheters; Diseases of the cardiovascular system; Female; Follow-Up Studies; Heart Valve Diseases - therapy; Humans; Male; Medical sciences; Mitral Valve; Ostomy; Patients; Pulmonary arteries; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Software; Statistical analysis; Short term; Mitral valve; Prognosis; Instrumentation therapy; Cardiovascular disease; Narrowing; Commissurotomy; Percutaneous route; Randomization; Cardiac valvular disease; Follow up study; Technique; Comparative study
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1067/mhj.2002.125621

Background The Inoue balloon technique for mitral commissurotomy is well established and carried out worldwide. Metallic commissurotomy is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. Methods One hundred patients were randomized into 2 groups to undergo percutaneous transmitral commissurotomy (PTMC) by means of the Inoue balloon technique (IBMC, n = 49) or metallic commissurotomy (PMMC, n = 51). Patients were crossed over to the other technique when the initial technique was a failure. Success of valvotomy, procedure-related complications, and follow-up events of the 2 techniques were compared. Results Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups: 45 of 49 procedures (91.8%) in the IBMC group, compared with 46 of 51 procedures (90.18%) in the PMMC group (P = 1.0). Crossover was also comparable, with 1 occurring in the IBMC group, compared with 3 in the PMMC group. Complications such as cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups, with 3 complications in the IBMC group, compared with 4 complications in the PMMC group (P =.29). After a follow-up period of approximately 4 months, both groups had similar event rates and comparable hemodynamic parameters (P = not significant). Conclusions Both IBMC and PMMC are successful means of providing relief from severe mitral stenosis with a gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success, complication rates, and follow-up events. (Am Heart J 2002;144:1074-80.)