Concurrent antegrade transseptal inoue-balloon mitral and aortic valvuloplasty

Authors

  • Sayed M. Abdou MD,

    1. Division of cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Cardiology Department, National Heart Institute, Cairo, Egypt
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    • Conflict of interest: Nothing to report.

  • Yung-Lung Chen MD,

    1. Division of cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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    • Conflict of interest: Nothing to report.

  • Chiung-Jen Wu MD,

    1. Division of cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Kean-Wah Lau MBBS, FRCP,

    1. Division of Cardiology, Department of Internal Medicine, Gleneagles Hospital, Singapore
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  • Jui-Sung Hung MD

    Corresponding author
    1. Department of Internal Medicine, China Medical University, Taichung, Taiwan
    • Correspondence to: Jui-Sung Hung, Department of Internal Medicine, China Medical University, Yuh Der Road No. 2, Taichung 404, Taiwan. E-mail: feymanchen@yahoo.com.tw

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  • S. M. A. and Y.-L.C. contributed equally in this study.

  • C.-J.W. and J.-S.H. contributed equally in this study.

Abstract

Background

The Inoue balloon has been in use for many years for mitral valvuloplasty. Aortic valvuloplasty using the Inoue balloon via transseptal approach was developed in the hope of providing better results with less potential vascular access complications.

Methods and Results

In this study, we present our experience in percutaneous valvuloplasty using the Inoue balloon in 14 patients with combined rheumatic mitral and aortic stenosis (AS) in a single stage procedure via antegrade transseptal approach. The study group was characterized by relatively young age (mean 37.5 ± 9.6 years). Aortic followed by mitral valvuloplasty via antegrade approach resulted in a fall of transaortic peak pressure gradient (PG) from 59.1 ± 11.2 mm Hg to 25.3 ± 12.5 mm Hg (P = 0.012) and mean from 49.0 ± 10.9 mm Hg to 16.6 ± 9.8 mm Hg (P = 0.043). Aortic valve areas increased significantly from 0.70 ± 0.25 cm2 to 1.41 ± 0.48 cm2 (P = 0.042). Mean transmitral PG decreased from 14.9 ± 2.1 mm Hg to 5.3 ± 1.5 with increase of mitral valve areas from 1.08 ± 0.45 to 1.92 ± 0.51 cm2. The procedures were well tolerated without development of significant valvular regurgitation or thromboembolism. During follow-up, 2 patients died due to lung cancer and sudden death at months 48 and 100. Five patients received delayed surgery after mean duration of 73.4 ± 39.7 months.

Conclusions

Concurrent antegrade, transseptal Inoue-balloon aortic and mitral valvuloplasty, is feasible and safe, and provides excellent immediate results as one-stage procedure. The study results also suggest that balloon aortic valvuloplasty can be more durable in younger patients with rheumatic AS than in elderly patients with degenerative, AS. However, the modified aortic valvuloplasty technique can be utilized only as bridging procedure to aortic valve replacement or recently developed transcatheter aortic-valve implantation in unstable hemodynamic status, and as a palliative procedure before noncardiac surgery. © 2012 Wiley Periodicals, Inc.

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