Specification of the role of echocardiographic guidance during balloon mitral valvuloplasty

Objective: To evaluate the outcomes of balloon mitral valvuloplasty (BMV) for mitral valve stenosis (MVS) performed under ultrasound guidance, and to summarize the role of echocardiography (EchoCG) in the diagnosis and treatment of rheumatic mitral stenosis (MS).

Materials and Methods: This study included 47 patients with MS who underwent BMV using the Inoue technique, with echocardiography employed as an auxiliary method for procedural guidance. The majority of patients were women—39 (82.9%). The mean age was 49.8 ± 6.14 years. Sinus rhythm was present in 35 (74.5%) patients, while atrial fibrillation (AF) was observed in 12 (25.5%).

Results: The mean duration of the procedure (from venous puncture to catheter removal) was 48.76 ± 6.48 minutes. The average size of the balloon catheter was 26.3 ± 0.91 mm. The mean transmitral pressure gradient decreased significantly from 14.15 ± 2.75 mmHg to 6.1 ± 1.15 mmHg (p < 0.05). The mean pulmonary artery pressure (PAP) was reduced from 28.48 ± 2.26 mmHg to 15.2 ± 3.68 mmHg (p < 0.05). Left atrial (LA) pressure dropped from 27.86 ± 3.87 mmHg to 13.4 ± 2.75 mmHg (p < 0.05) after BMV. The mitral valve area (MVA) increased from 0.95 ± 0.14 cm² to 1.89 ± 0.25 cm² (p < 0.05). No intraoperative or postoperative complications were observed. The mean follow-up duration was 11.35 ± 1.14 months.

Conclusion: BMV is an effective and safe treatment option for selected patients with MS. Echocardiography not only plays a central role in diagnosing MS but should also be integrated into all stages of the BMV procedure. Enhancing the use of echocardiographic guidance during endovascular intervention can significantly reduce radiation exposure, and potentially eliminate its need altogether in the future.

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