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Palacios Mini-invasive Surg 2020;4:73 I http://dx.doi.org/10.20517/2574-1225.2020.72 Page 7 of 24

Figure 4. Short axis video loops from a patient with severe mitral stenosis and Concentric MS (right panel) and one patient with Eccentric
MS (left panel). MS: mitral stenosis

Figure 5. Double balloon mitral valvuloplasty

multi-track system [Figure 6] is a variant of the double-balloon technique and aims to make the procedure
[36]
easier through the use of a monorail balloon and only a single guidewire . The Inoue technique [Figure 7]
has become the most popular technique worldwide [4,16,18,22,37] . The design of the Inoue balloon allows safe
and fast positioning across the valve. In addition, it is pressure extensible, allowing for the performance of
a stepwise dilatation [Figure 7]. The available data comparing the Inoue technique and the double-balloon
technique suggest that the Inoue technique makes the procedure easier, and that both techniques have
equivalent efficacy. Although the double-balloon technique may result in a slightly larger post-PMV valve
area, the long-term results are equivalent. Furthermore, the Inoue balloon carries a lower risk because the
risk of left ventricular perforation is virtually avoided [16,23,37] .