Comparative results of percutaneous balloon mitral valvuloplasty using the Trefoil/Bifoil and Inoue balloon techniques.

This study compared the results in 150 consecutive patients with rheumatic mitral stenosis who underwent percutaneous balloon mitral valvuloplasty by means of a Trefoil/Bifoil balloon catheter (n = 100, Group 1) or the Inoue balloon catheter (n = 50, Group 2). There was significant improvement in mitral valve area after valvuloplasty in both groups: in Group 1 mitral valve area improved from 0.92 +/- 0.22 to 2.14 +/- 0.64 cm2 (P < 0.001) and in Group 2 from 1.0 +/- 0.26 to 2.06 +/- 0.59 cm2 (P < 0.001). There was no significant difference in the mitral valve area, mean diastolic gradient or mean left atrial pressure between Group 1 and Group 2 patients after valvuloplasty. There was a higher complication rate in Group 1 patients but this was largely related to our early learning experience with the procedure. The Trefoil/Bifoil catheter technique is more complex and involved a longer screening time: Group 1 (39 +/- 15 min) vs. Group 2 (22 +/- 10 min); P < 0.001. The cost of the Inoue balloon technique, however, was almost twice that of the Trefoil/Bifoil technique. This may have important implications for developing countries with limited health care budgets and a high prevalence of rheumatic heart disease.