Balloon Compression Sign During Balloon Mitral Valvotomy: An Old Sign Revisited

J INVASIVE CARDIOL 2020;32(12):E378. 

Key words: BMV, balloon mitral valvotomy

A 50-year-old Indian woman who was a laborer by occupation presented to the emergency department with gradually progressive exertional dyspnea from New York Heart Association class II-IV for 15 years. She was married and had 2 children with uneventful deliveries. The physical examination revealed a grade III parasternal heave, a loud S1, a pansystolic murmur (grade 4/6) at the left lower sternal border, and a low-pitched, long diastolic rumble at the apex. Transthoracic echocardiography revealed very severe mitral stenosis (calculated valve area by planimetry, 0.8 cm²; normal, 4-6 cm²) and severe tricuspid regurgitation with mild pulmonary hypertension. Her Wilkin’s score was 8/16 (subvalvular = 3, mobility = 2, calcification = 1, leaflet thickening = 2). After proper consent, she was taken for balloon mitral valvotomy. During half inflation of the Inoue balloon (Figure 1A) and full inflation of the Inoue balloon (Figure 1B), indentation and compression of Inoue balloon was seen (Video 1), which is indirect evidence of severe subvalvular disease. There were no intraoperative complications. The mitral valve increased to 1.3 cm² and mean left atrial pressure decreased from 25 mm Hg to 8 mm Hg (normal, 8 mm Hg). Severe subvalvular disease predicts poor outcomes in balloon mitral valvotomy.

From the Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted February 26, 2020.

Address for correspondence: Sourabh Agstam, MBBS, MD, DM, Assistant Professor in Cardiology, VMMC and Safdarjung Hospital, New Delhi, India. Email: sourabhagstam@gmail.com