ABSTRACT
The role of percutaneous balloon valvuloplasty (PMV) has continued to develop since Inoue et al1 described the technique nearly 20 years ago. Progressive improvements in equipment, operator experience, and case selection have contributed to the emergence of PMV as the management procedure of choice for patients with important mitral stenosis. Numerous large series suggest that the most important predictor of success is careful case selection.2-7 Present guidelines from the American Heart Association (AHA)/American College of Cardiology (ACC) state: ‘In centers with skilled, experienced operators, PMV should be considered the initial procedure of choice for symptomatic patients with moderate to severe mitral stenosis who have a favorable valve morphology in the absence of significant mitral regurgitation or left atrial thrombus. In asymptomatic patients with favorable valve morphology, PMV may be considered if there is evidence of a hemodynamic effect on left atrial pressure (new-onset atrial fibrillation) or pulmonary circulation (pulmonary artery pressure >50 mmHg at rest or >60 mmHg with exercise)’ (Table 30.1).8
