ABSTRACT
Percutaneous trans-venous mitral commissurotomy (PTMC) is the current standard of care for rheumatic mitral stenosis (MS). It has also been termed as balloon mitral valvotomy, percutaneous mitral valvotomy or percutaneous balloon mitral valvotomy. Various techniques for the percutaneous therapy of MS have evolved over the time but currently, Inoue’s technique is almost exclusively used world over. The indications for PTMC have been covered in the earlier chapter. Left atrial (LA) thrombus, more than 2/4 mitral regurgitation (MR) and severe bicommissural calcification are the only absolute contraindications for PTMC. Other valvular diseases or coronary artery disease requiring surgery are also contraindication for PTMC. Relative contraindications include left atrial appendage (LAA) thrombus, grade 2/4 MR, calcific valve, commissural calcification, significant subvalvular disease (SVD) and distorted anatomy. For the same degree of MR, a central jet of MR is more favorable for performing PTMC than an eccentric jet of MR. In this chapter, technical details and hardware used in routine PTMC will be discussed.
