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Percutaneous mitral balloon valvotomy for mitral stenosis

John D Carroll, MD
William H Gaasch, MD
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Mitral stenosis (MS) is a disabling and eventually lethal disease. Untreated progressive disease can lead to significant symptoms (eg, dyspnea and fatigue) and serious complications (eg, pulmonary edema, systemic embolism, and pulmonary hypertension). The great majority of cases in adults are due to rheumatic heart disease, with symptoms usually appearing 16 to 40 years after the episode of acute rheumatic fever. (See "Pathophysiology and natural history of mitral stenosis".)

Although medical therapy can relieve symptoms, it does not affect the obstruction to flow. As a result, surgical commissurotomy and open valvuloplasty were, for many years, the only methods by which MS could be corrected. However, the development of percutaneous mitral balloon valvotomy (PMBV) by Inoue in 1984 and Lock in 1985 for the treatment of selected patients with MS has revolutionized the treatment of this disorder [1-3].

The efficacy of PMBV, including comparison with surgery, and the management of patients with MS undergoing PMBV will be reviewed here. Issues directly related to the timing of intervention, and the medical and surgical management of MS are discussed separately. (See "Surgical management of mitral stenosis" and "Medical management and indications for intervention for mitral stenosis".)


Rheumatic MS — Patients are selected for percutaneous mitral balloon valvotomy (PMBV) on the basis of hemodynamic and echocardiographic criteria. PMBV is generally performed in chronically symptomatic patients, and may also include those who present emergently with cardiac arrest, cardiogenic shock, or pulmonary edema [4,5]. Asymptomatic patients who plan on childbearing or major noncardiac surgery may also be candidates for this procedure. Prophylactic valvotomy for the prevention of systemic emboli or atrial fibrillation is not a firmly established criterion.

When intervention is warranted, the 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines generally recommended that PMBV is preferred to surgery if the valve morphology is favorable and the patient does not have left atrial thrombus or moderate to severe (3+ to 4+) mitral regurgitation [4].


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Literature review current through: Sep 2016. | This topic last updated: Aug 15, 2016.
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