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Inoue balloon dilatation of a mitral valve bioprosthesis

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A 54 year old female patient had severely calcific rheumatic mitral stenosis causing limiting exertional dyspnoea in 1988; she was treated by implantation of an Edwards pericardial valve with resolution of symptoms. In 1997 she developed recurrent breathlessness owing to stenosis of the bioprosthetic valve with an estimated valve area of 0.9 cm2. She was treated with Inoue balloon dilatation of the bioprosthetic valve. Top figure (A) shows the balloon positioned through the mitral valve in the left ventricle. The balloon is partially inflated (the distal portion opening first). The balloon is then withdrawn to be positioned across the mitral bioprosthetic valve (B), and then fully inflated (C). Following this procedure the gradient between left atrial and left ventricular pressure is almost completely abolished (bottom). Left venticulography confirmed that balloon dilatation had not caused mitral regurgitation.

The literature regarding balloon dilatation of stenosed bioprothetic valves is limited to case reports and small series. Although the medium and long term outcome is less clear than for native mitral stenosis, balloon dilatation of bioprostheses may be a way to delay or avoid the hazards of repeat mitral surgery in some patients.