Is percutaneous mitral/aortic balloon valvuloplasty performed through left heart cardiac catheterization (Cardiac Catheterization)?

From the Guidelines

Yes, percutaneous mitral and aortic balloon valvuloplasty are typically performed through left heart cardiac catheterization. The procedure involves accessing the left side of the heart to reach the affected valve. For mitral valvuloplasty, a catheter with a balloon at its tip is inserted through a vein, usually in the groin, and then guided across the atrial septum into the left atrium and down to the mitral valve. For aortic valvuloplasty, the catheter is inserted through an artery, typically the femoral artery, and advanced retrograde through the aorta to the aortic valve. Once positioned across the stenotic valve, the balloon is inflated to stretch and separate the fused valve leaflets, improving blood flow. This minimally invasive approach avoids open-heart surgery while providing relief from valve stenosis. The procedure is most commonly used for patients with mitral stenosis, particularly those who are not good candidates for surgery, and less frequently for aortic stenosis as a bridge to more definitive treatment or for palliation in high-risk patients 1.

Key Considerations

• The success of percutaneous mitral balloon valvotomy is dependent on the morphology of the mitral valve apparatus and the experience of the operator 1.
• Patients with pliable, noncalcified valves and minimal fusion of the subvalvular apparatus achieve the best immediate and long-term results 1.
• The procedure is not indicated for patients with mild mitral stenosis or those with moderate to severe mitral regurgitation or left atrial thrombus 1.

Procedure Details

• The procedure involves the use of a catheter with a balloon at its tip, which is guided to the affected valve under fluoroscopy and echocardiography guidance 1.
• The balloon is inflated to stretch and separate the fused valve leaflets, improving blood flow and reducing the gradient across the valve 1.
• The procedure can be performed using a double-balloon technique or an hourglass-shaped single balloon, such as the Inoue balloon 1.

Outcomes and Risks

• The immediate results of percutaneous mitral valvotomy are similar to those of surgical commissurotomy, with a significant improvement in symptoms and hemodynamics 1.
• The procedure is associated with a risk of complications, including severe mitral regurgitation, atrial septal defect, and embolic events 1.
• The mortality rate with balloon valvotomy is generally low, ranging from 1% to 2%, but may be higher in patients with underlying comorbidities or more severe valve disease 1.

From the Research

Percutaneous Mitral/Aortic Balloon Valvuloplasty Procedure

• The procedure of percutaneous balloon valvuloplasty involves inserting one or more large balloons percutaneously and then inflating them across a stenotic valve to decrease the degree of obstruction 2.
• This procedure can be performed for patients with pulmonic, mitral, or aortic stenosis, with varying results depending on the type of valve and the age of the patient 2.
• For mitral stenosis, the results of balloon valvuloplasty depend on the morphologic features of the stenotic valve, with better results for patients with a pliable, noncalcified mitral valve 2, 3.

Left Heart Cardiac Catheterization

• Percutaneous balloon mitral valvuloplasty (PBMV) provides an effective alternative to surgery in a selective group of patients with symptomatic mitral stenosis, and involves transseptal catheterization followed by catheter manipulation to cross the mitral valve 4.
• Left ventricular systolic pressure can be used as a guide to locate and advance the balloon catheter across the mitral valve 4.
• Transcatheter mitral valve replacement (TMVR) procedures have also been reported, separately or simultaneously with transcatheter aortic valve replacement (TAVR) 5.

Combined Mitral and Aortic Valve Procedures

• Combined aortic and mitral valve surgery is a common form of double-valve surgery, with varying outcomes depending on the etiology or pathophysiology of the valvular dysfunction 6.
• Simultaneous transapical TAVR and TMVR in native valves secondary to valvular stenosis has been reported, with sizing of the valves based on transesophageal echocardiogram (TEE) measurements and balloon inflation during left ventriculography 5.