Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty: which is preferable?

BACKGROUND: Percutaneous balloon mitral valvuloplasty (BMV) is an important option for the treatment of mitral valve stenosis. The crux of this process is choosing the appropriate Inoue balloon size. There are two methods to do this. One is an empirical formula based on the patient’s height, and other is to choose according to the maximal inter-commissural distance of the mitral valve provided by echocardiography. METHODS: The study, performed between January 2006 and December 2011, included 128 patients who had moderate to severe mitral stenosis and whose valve morphology was suitable for BMV. Patients were randomised into two groups. One group was allocated to conventional height-based balloon reference sizing (the HBRS group) and the other was allocated to balloons sized by the echocardiographic measurement of the diastolic inter-commissural diameter (the EBRS group). RESULTS: BMV was assessed as successful in 60 (92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p = 0.03). The mean of the calculated balloon reference sizes was significantly higher in the HBRS than in the EBRS group [26.3 ± 1.2 mm, 95% confidence interval (CI): 26.1–26.6 vs 25.2 ± 1.1, 95% CI: 25.0–25.4, respectively; p = 0.007). Final mitral valve areas (MVA) were larger and mitral regurgitation (MR) > 2+ was less in the EBRS group (p = 0.02 and p = 0.05, respectively). CONCLUSIONS: EBRS is a method that is independent of body structure. Choosing Inoue balloon size by measuring maximal diastolic annulus diameter by echocardiography for BMV may be an acceptable method for appropriate final MVA and to avoid risk of significant MR.