Percutaneous transvenous mitral commissurotomy using the inoue balloon catheter

Since its inception in 1982, percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter has gained increasingly wide use internationally. The procedure is technically successful in over 90% of patients, and the long-term durability of commissurotomy is excellent in those with pliable mitral valve leaflets and minimally deformed submitral apparatus. PTMC offers an alternative to patients previously not considered candidates for surgery, where no alternative had existed in the past. After transseptal puncture, PTMC using the Inoue balloon can be accomplished easily in the majority of patients. In comparison to double balloon mitral valvotomy, the postdilatation valve area is similar, the incidence of mitral regurgitation is not different, and the fluoroscopic and procedure time are markedly shorter. While patients with little valve deformity are excellent candidates for this procedure, and those not considered candidates for surgical therapy are also easily defined, selection of patients for balloon dilatation among those with significant valve deformity who are otherwise candidates for valve replacement therapy remains a challenging problem.