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Palacios Mini-invasive Surg 2020;4:73 I http://dx.doi.org/10.20517/2574-1225.2020.72 Page 3 of 24

Table 1. Recommendations for percutaneous mitral valvuloplasty
Current indication Class Level of evidence
2
Asymptomatic patients with moderate or severe mitral stenosis (area < 1.5 cm ) and I Grade A
valve morphology favorable for PMV who have pulmonary hypertension (PA pressure
systolic > 50 mmHg at rest or 60 mmHg with exercise) in the absence of left atrium
thrombus or moderate to severe MR
Patients with NYHA functional class II-IV, moderate or severe mitral stenosis (area < Ia Grade C
2
1.5 cm ), a non-pliable calcific valve who are at high risk for surgery in the absence of
left atrium thrombus or moderate to severe MR
2
Asymptomatic patients, moderate or severe mitral stenosis (area < 1.5 cm ) and valve IIa Grade B
morphology favorable for PMV, who has new onset of atrial fibrillation in the absence
of left atrium thrombus, and moderate to severe MR
Patients with NYHA functional Class II-IV, moderate to severe mitral stenosis (area < IIb Grade C
2
1.5 cm ), and non-pliable calcified valve who are low risk for surgery
Patients with mild mitral stenosis III Grade C
Adapted from current American College of Cardiology/American Heart Association [13] and European [14] guidelines for the management
of patients with valvular heart disease. PMV: percutaneous mitral balloon valvuloplasty; MR: mitral regurgitation; NYHA: New York
Heart Association Functional Class of Heart Failure

Table 2. Immediate changes in mitral valve area after PMV
Author Institution # Patients Age Pre-PMV Post-PMV
Palacios et al. [10] MGH 1,085 55 ± 15 0.9 ± 0.3 1.9 ± 0.6
Lung et al. [22] Tenon 1,024 45 ± 15 1.0 ± 0.2 1.9 ± 0.3
Hernandez et al. [17] Clınico Madrid 561 53 ± 13 1.0 ± 0.2 1.8 ± 0.4
Stefanadis et al. [35] Athens University 438 44 ± 11 1.0 ± 0.3 2.1 ± 0.5
Chen et al. [11] Guangzhou 4,832 37 ± 12 1.1 ± 0.3 2.1 ± 0.2
Dean et al. [9] Multicenter 738 54 ± 12 1.0 ± 0.4 2.0 ± 0.2
Herrmann et al. [18] Multicenter 200 53 ± 15 1.0 ± 0.3 1.8 ± 0.7
Feldman et al. [37] Multicenter 260 53 ± 15 1.0 ± 0.3 1.8 ± 0.6
Reyes et al. [44] Fattouma 463 33 ± 12 1.0 ± 0.2 2.2 ± 0.4
Arora et al. [19] G.B. Pan 600 27 ± 8 0.8 ± 0.2 2.2 ± 0.4
Cribier et al. [38,39] Rouen 153 36 ± 15 1.0 ± 0.2 2.2 ± 0.4
Modified from Palacios IF. Percutaneous mitral balloon valvuloplasty for patients with rheumatic mitral stenosis . MGH: Massachusetts
[1]
General Hospital; PMV: percutaneous mitral balloon valvuloplasty

Table 3. Complications after PMV
Author Pts Mortality Tamponade Severe MR Embolism
Palacios et al. [10] 1,085 0.6% 0.8% 2.7% 1.2%
Vahanian et al. [16] 200 0.0% 0.3% 3.4% 0.3%
Lung et al. [22] 1,024 0.4% 0.0% 4.0% 4.0%
Hernandez et al. [17] 561 0.4% 0.6% 4.5%
Stefanadis et al. [35] 438 0.2% 0.0% 3.4% 0.0%
Chen et al. [11] 4,832 0.1% 0.8% 1.4% 0.5%
Dean et al. [9] 738 3.0% 4.0% 3.0% 3.0%
Herrmann et al. [18] 200 0.6% 1.0% 2.4% 1.5%
Feldman et al. [37] 260 1.1% 0.7% 4.0% 0.7%
Reyes et al. [44] 463 0.4% 0.7% 4.6% 2.0%
Arora et al. [19] 600 1.0% 1.3% 1.0% 0.5%
Cribier et al. [38,39] 153 0.0% 0.7% 1.4% 0.7%
[1]
Modified from Palacios IF. Percutaneous mitral balloon valvuloplasty for patients with rheumatic mitral stenosis . PMV: percutaneous
mitral balloon valvuloplasty; MR: mitral regurgitation
commissurotomy [10,11,18-20] . Nowadays, PMV is the preferred form of therapy for relief of mitral stenosis for a
selected group of patients with symptomatic rheumatic mitral stenosis.

The Wilkin’s echocardiographic score (Echo-Sc) is currently the most widely used method for patient
selection predicting PMV outcome [7,12] (Figure 1, panels A and B display video loops for low and high Echo