Mitral balloon valvuloplasty (PMBV - Percutaneous Mitral Balloon Valvuloplasty) is the catheter-based treatment of mitral valve stenosis. This method, particularly effective for rheumatic mitral stenosis, is a minimally invasive alternative to open heart surgery.
What is Mitral Valve Stenosis?#
The mitral valve is located between the left atrium and left ventricle. Mitral stenosis is the narrowing of this valve, making it difficult for blood to flow from the left atrium to the left ventricle.
Causes of Mitral Stenosis#
| Cause | Description | Frequency |
|---|---|---|
| Rheumatic | Previous rheumatic fever | Most common (90%) |
| Degenerative | Age-related calcification | Rare |
| Congenital | Birth defect | Very rare |
| SLE/RA | Autoimmune diseases | Rare |
Symptoms of Mitral Stenosis#
- Shortness of breath (especially with exertion)
- Palpitations (atrial fibrillation)
- Fatigue
- Ankle swelling
- Chest pressure
- Blood-tinged sputum (advanced stage)
What is Mitral Balloon Valvuloplasty?#
PMBV is the procedure of dilating the mitral valve using a special balloon catheter inserted through the femoral vein. Developed by Dr. Kanji Inoue in 1984, this technique has become the standard treatment worldwide.
Advantages of the Procedure#
- ✅ No open heart surgery required
- ✅ May not require general anesthesia
- ✅ Completed in 1-2 hours
- ✅ 1-2 day hospital stay
- ✅ Quick recovery
- ✅ Repeatable
- ✅ Safe during pregnancy
Who is Suitable for PMBV?#
Indications#
Absolute Indications:
- Symptomatic moderate-severe mitral stenosis (MVA ≤1.5 cm²)
- Suitable valve anatomy (Wilkins score ≤8)
- No significant mitral regurgitation (≤2+)
- No thrombus in left atrium
Relative Indications:
- Asymptomatic severe mitral stenosis + pulmonary hypertension
- Pregnant patients
- High surgical risk patients
- NYHA class III-IV symptoms
Contraindications#
- Severe mitral regurgitation (≥3+)
- Left atrial thrombus
- Severe bicommissural calcification
- Severe aortic valve disease
- Active endocarditis
Wilkins Score - Valve Suitability#
A scoring system used to assess valve anatomy suitability:
| Parameter | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| Mobility | Good | Moderate | Limited | Very limited |
| Thickening | Minimal | Tip thickening | Widespread | Severe |
| Calcification | None | Mild | Moderate | Extensive |
| Subvalvular | Normal | Mild | Moderate | Severe |
Assessment:
- Total ≤8: Excellent candidate ✅
- Total 9-11: Acceptable candidate
- Total ≥12: Not suitable for PMBV ❌
Pre-Procedure Preparation#
Evaluation#
Transthoracic Echocardiography (TTE)
- Valve area measurement
- Wilkins score
- Mitral regurgitation degree
- Pulmonary pressure
Transesophageal Echocardiography (TEE)
- Left atrial thrombus screening
- Detailed valve anatomy
- On procedure day or 24-48 hours before
Laboratory Tests
- Complete blood count
- Coagulation tests
- Kidney function
- Thyroid function
Procedure Technique#
Step-by-Step PMBV#
1. Vascular Access
- Right femoral vein puncture
- Guidewire placement
2. Transseptal Puncture
- Passage from right atrium to left atrium
- Needle puncture through fossa ovalis
- Critical step requiring experience
3. Left Atrial Entry
- Dilator and sheath placement
- Anticoagulation (heparin)
4. Balloon Catheter Placement
- Inoue balloon advanced into left atrium
- Passed through mitral valve orifice
5. Balloon Inflation
- Stepwise inflation technique
- Distal portion first, then proximal
- Separation of valve commissures
6. Result Assessment
- Pressure measurements
- Echocardiographic control
- Mitral regurgitation evaluation
Success Criteria#
Optimal Outcome#
| Parameter | Target |
|---|---|
| Mitral valve area | ≥1.5 cm² or 50% increase |
| Mean gradient | ≤5 mmHg |
| Mitral regurgitation | ≤2+ |
| Complications | None |
Success Rates#
- Procedural success: 95-98%
- 10-year restenosis-free survival: 60-80%
- 15-year restenosis-free survival: 40-60%
Complications and Management#
Early Complications#
| Complication | Frequency | Management |
|---|---|---|
| Severe mitral regurgitation | 1-2% | Emergency surgery |
| Cardiac tamponade | <1% | Pericardiocentesis |
| Systemic embolism | <1% | Anticoagulation |
| Atrial septal defect | 5-10% | Most close spontaneously |
| Vascular complication | 2-3% | Local repair |
Late Complications#
- Restenosis: 2-4% per year
- Atrial fibrillation: Requires follow-up and treatment
Post-Procedure Follow-up#
In Hospital#
- 24 hours bed rest
- ECG and hemodynamic monitoring
- Control echocardiography
- Discharge in 1-2 days
After Discharge#
Medication:
- Aspirin (short-term)
- Anticoagulant for atrial fibrillation
- Diuretic (if needed)
Follow-up Schedule:
- 1 week: Clinical check
- 1 month: Echocardiography
- 6 months: Echocardiography
- Then annual follow-up
Frequently Asked Questions#
What is mitral balloon valvuloplasty?
Who is a candidate for mitral balloon valvuloplasty?
How long is recovery after mitral balloon valvuloplasty?
Is mitral balloon valvuloplasty permanent?
What are the risks of mitral balloon valvuloplasty?
Appointment and Contact#
To schedule an appointment for mitral valve stenosis evaluation and treatment options:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Structural Heart Interventions#
Other services related to mitral balloon valvuloplasty:
- TAVI - Transcatheter aortic valve implantation
- MitraClip - Mitral valve clipping
- Tricuspid Valve - Tricuspid valve interventions
- Heart Hole Closure - ASD/PFO closure