Percutaneous mitral valvoplasty: 30 years of experience.

Mitral Valve; Balloon Dilatation / history. In 1982, Kanjii Inoue, a Japanese cardiac surgeon, developed the concept that a thickened and deteriorated mitral valve could be widened as a synthetic balloon. This concept was similar to the one used in the surgical closed mitral commissurotomy1. Subsequently, the double-balloon technique was introduced in Saudi Arabia as an alternative method to the valvoplasty with Inoue balloon2. Nowadays, the Inoue technique became the most used method for the accomplishment of percutaneous mitral valvoplasty. In comparison to the double-balloon technique, it has similar efficacy with the additional benefit of presenting lower peri-procedures risks3. If contrasted with the surgical mitral commissurotomy, mitral valvoplasty with balloon shows similar or superior successfull rates4,5, with equivalent restenosis averages5. Randomized studies, which compared the mitral valvoplasty with balloon to the surgical closed commissurotomy, have demonstrated that the percutaneous technique overpasses surgery for it results in a larger valve area with a superior duration at long term6. In this edition of the Archives, Cardoseo et al7 present the immediate and the latest results of the percutaneous mitral valvoplasty in patients with mitral stenosis, in a series of 330 consecutive patients that were followed during 47±36 months, evaluating the factors related to the procedure success, restenosis and the latest adverse clinical events7. The authors have concluded that mitral valvoplasty with balloon is an effective procedure, since more than 60% of the patients were free of events at the end of the follow-up. The echocardiographic score below 8 points was the only variable with independent predictive value for immediate success. The multivariate analysis also showed that the preprocedure mitral valve area and the presence of accentuated mitral calcification were the only independent predictors of post-procedure restenosis. With regard to the occurrence of adverse cardiovascular events, more advanced age; less pre-procedure mitral valve area; and major value of medium transvalve mitral gradient in the immediate post-procedure were considered as independent indicators. It is a highly laudable, observational study because it portrays the results of mitral valvoplasty in an essential number of patients, who were followed during a notable long period. If the procedure’s efficacy had already been established through the randomized studies, its effectiveness in the so called “real world” is now unequivocally documented.