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Palacios Mini-invasive Surg 2020;4:73 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.72

Review Open Access

Percutaneous mitral balloon valvuloplasty - state of
the art

Igor F. Palacios

Director of Interventional Cardiology Emeritus, Division of Cardiology, Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston, MA 01890, USA.
Correspondence to: Prof. Igor F. Palacios, Division of Cardiology, Department of Medicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 01890, USA. E-mail: ipalacios@mgh.harvard.edu
How to cite this article: Palacios IF. Percutaneous mitral balloon valvuloplasty - state of the art. Mini-invasive Surg 2020;4:73.
http://dx.doi.org/10.20517/2574-1225.2020.72
Received: 8 Jul 2020 First Decision: 7 Aug 2020 Revised: 13 Aug 2020 Accepted: 18 Aug 2020 Published: 24 Oct 2020

Academic Editor: Azeem Latib Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Since its introduction in 1982, percutaneous mitral balloon valvuloplasty (PMV) has been used successfully as
an alternative to open or closed surgical mitral commissurotomy in the treatment of patients with symptomatic
rheumatic mitral stenosis. PMV is safe and effective and provides sustained clinical and hemodynamic
improvement in patients with mitral stenosis. The immediate and long-term results appear to be similar to
those of surgical mitral commissurotomy. Proper patient selection is an essential step for being able to predict
the immediate results of PMV. Candidates for PMV require precise assessment of the mitral valve morphology.
The Wilkin’s echocardiographic score (Echo-Sc) is currently the most widely used method for predicting
PMV outcome. Leaflet mobility, leaflet thickening, valvular calcification, and sub valvular disease are each
scored from 1 to 4. An inverse relationship exists between the Echo-Sc and PMV success. Both immediate and
intermediate follow-up studies have shown that patients with Echo-Sc ≤ 8 have superior results, significantly
greater survival, and event free survival compared to patients with Echo-Sc > 8. We identified other clinical
and morphologic predictors of PMV success that include age, pre-PMV mitral valve area, history of previous
surgical commissurotomy, and mitral regurgitation (MR), and post-PMV variables (e.g., post-PMV MR ≥ 3 + and
pulmonary artery pressure), that may be used in conjunction with the Echo-Sc to optimally identify candidates
for PMV. This concept demonstrates a multifactorial nature of the prediction of immediate and long-term results.
Other echocardiographic scores have been developed for the screening of potential candidates for PMV. They
include a unique score that take into account the length of the chordae. A novel quantitative score that included
the ratio of the commissural areas over the maximal excursion of the leaflets from the annulus in diastole. The
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components of this score include mitral valve area ≤ 1 cm , maximum leaflet displacement ≤ 12 mm, commissural
area ratio ≥ 1.25, and sub valvular involvement. Finally, a score that is able to identify patients who are more
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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