Percutaneous by Retrograde

Balloon Mitral Valvuloplasty Left Atrial Catheterization

Christodoulos Stefanadis, MD, Costas Kourouklis, MD, Costas Stratos, MD, Christos Pitsavos, MD, Costas Tentolouris, MD, and Pavlos Toutouzas, MD

A new technique was developed for percutaneous mitral valve balloon vahruloplasty, using a retrograde approach to the left atrium via the left ventricle. A newly desigkd externally steerable guiding catheter is used for the introduction of 1 or 2 guldewires to the Ml atrium and the balloon catheters are advanced along these guidewires into the mitral orifice. The technique was used succeMully in 10 adult patients with rheumatic mitral stenosis. After the procedure there was a significant reduction in mitral valve pressure gradient and an increase in the mitral valve area In all cases. There were no serious complications during or after the procedure. Thii technique should prove to be a useful nonsurgical treatment for mitral stenosis and could provide an alternative to the transseptal method. (Am J Cardiol 1990;65:666-664)

From the Department of Cardiology, University of Athens Medical School, Athens, Greece. Manuscript received July 20, 1989; revised manuscript received and accepted November 6, 1989. Address for reprints: C. Stefanadis, MD, Tepeleniou 9, Paleo PsyChico, GR-154 52 Athens, Greece.








ercutaneous balloon valvuloplasty has made a significant contribution to the nonsurgical treatment of mitral valve stenosis.l-10 Various techniques have been described, involving variations in the method of approaching the stenotic valve and in the kinds of balloon ~sed.‘-~ However, all the well-established methods involve puncture of the atria1 septum, which occasionally leads to complications.2v7,11-13 Previous studies in our laboratory have shown that externally steerable catheters may be introduced easily and safely into the ascending aorta and left ventricle,14 and then retrogradely into the left atrium, even in patients with mitral stenosis (C. Stefanadis et al, unpub lished observations). We describe how such a catheter was used for the balloon mitral valvuloplasty. This method was tested in 10 patients with rheumatic mitral valve stenosis. METHOD6 Design and con&ucti on of the catheter system:

The steerable guiding catheter has a 9Fr diameter, is 110 cm long and has a soft tip. The proximal end is connected to a system with 2 hemostatic valves (Duostat@, Advanced Cardiovascular System Inc.) (Figure 1A). A O.OlZinch Teflon-coated stainless steel wire with a soft, flexible tip (the steering arm) passes through 1 of these valves and along the inside of the catheter, emerges 6 cm from the distal end and is fastened to the catheter wall 1.5 cm from the tip (Figure lB, C, D). The proximal end of the steering arm is attached to a plastic rod. The other hemostatic valve is used for the introduction of a guidewire, which is inserted through the guiding catheter to the left atrium. Catheterization technique: The steerable guiding catheter is introduced through a sheath to the right femoral artery and then, with the aid of a 0.038~inch guidewire, via the aorta to the left ventricle. The patient receives heparin (100 U/kg) and the steering arm is retracted, causing the catheter tip to bend into an arc of approximately 160°, and is fixed in position by tightening the hemostatic valve. The catheter is carefully rotated counterclockwise and retracted slightly, which brings the tip to a position below the mitral valve (Figure 2) as shown by the left and right anterior oblique projections. A 0.025inch J guidewire is inserted through the guiding catheter until it emerges from the tip. With careful manipulation of its distal end and, when necessary, minor adjustments to the steering arm of the guiding catheter, it is then advanced into the left atrium (Figure 3). The guiding catheter is withdrawn slightly and fmed in its final position, with its tip in the mitral


I Clinical

and Hemodynamic

Data Before PAP (mm

Pt 1 2 3 4 5 6 7 8 9

10 Mean f SEM

Age Ws). Sex


Cardiac Rhythm

31. F 40.M 46, F 51, M 52, F 56, M 57, F 60, F 62. F 67, F 52 f3

IV III III II ill Ill II Ill III Ill



and After



Cardiac O/P (liters/min)

(mm 4)









63 50 42 61 56 67 30 23 52 45 49 k5 p

Percutaneous balloon mitral valvuloplasty by retrograde left atrial catheterization.

A new technique was developed for percutaneous mitral valve balloon valvuloplasty, using a retrograde approach to the left atrium via the left ventric...
3MB Sizes 0 Downloads 0 Views