Retrograde nontransseptal balloon mitral valvuloplasty for rheumatic mitral stenosis

Retrograde nontransseptal balloon mitral valvuloplasty is a relatively new technique for dilating stenosed mitral valves, wherein a specially designed steerable catheter is used to enter the left atrium retrogradely. Over a 1-yr period, 52 patients (34 M, 18 F; mean age 26.4 +/- 6.5 yr) with symptomatic noncalcific rheumatic mitral stenosis underwent balloon mitral valvuloplasty by this technique at our center. The procedure was completed in 51 out of the 52 patients and technically successful dilatation was achieved in 47 (90.4%) patients. The mean valve area increased from 0.8 +/- 0.2 cm2 to 1.86 +/- 0.37 cm2 and end diastolic gradients decreased from 21.2 +/- 9.4 mm Hg to 4.0 +/- 2.2 mm Hg. Significant mitral regurgitation (> 2+) developed in two (3.9%) patients, and both remained stable on medical treatment. In two patients, there was a significant decrease in femoral pulse, which improved with thrombolytic therapy. Our study is the first report of this technique from a center other than that of its origin. The results of this study further establish that this new retrograde technique may be a useful alternative to the conventional transseptal techniques for mitral valvuloplasty.