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Hamid Reza Sanati, Majid Kiavar, Negar Salehi, Farshad Shakerian, Ata Firoozi, Saeed Alipour Parsa, Neda Behzadnia, Hooman Bakhshandeh, Mohammad Mehdi Peighambari and Majid Maleki
American Heart Hospital Journal Volume 8 No.1

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Background:
Since the introduction of the Inoue technique for percutaneous balloon mitral valvuloplasty (PBMV), various criteria have been proposed for ideal balloon sizing. In routine practice, balloon size is chosen based on the patient's height according to a simple formula. We tried to define a simple and practical echocardiographic measure for adjusting balloon catheter size to achieve better success rates and fewer complications.

Methods:
Patients with moderate to severe mitral stenosis who were candidates for PBMV were selected. Maximal mitral commissural diameter at a fully opened state during diastole was measured by transthoracic echocardiography and compared with the values from the height-based formula. Data were compared by paired sample t-test.

Results:
Eighty-three patients (mean age 45±13.2 years; 77 female) participated. The median balloon size was 28mm (standard deviation [SD] 1.2) according to the height-based formula and 26mm (SD 1.6) according to echocardiography (p< 0.001). Using a Bland-Altman plot, an excellent agreement was observed between the two methods. Regression models were fitted to estimate the balloon size using the patients' height, commissural diameter, and mitral valve score.

Conclusion:
Selection of balloon size according to echocardiographic commissural diameter is a good alternative method. Assuming the possible discrepancy between height-based and commissural-based estimated balloon sizes in some cases, adjustment of balloon sizes according to the maximal commissural diameter may result in acceptable results and fewer complications.

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Despite a dramatic fall in the incidence of rheumatic fever (RF), it continues to affect young people and is one of the main causes of acquired heart disease in developing and underdeveloped countries.¹ Rheumatic heart disease including mitral stenosis (MS) is one of the late manifestations of RF that could potentially result in debilitating symptoms and complications. After the advent of percutaneous therapeutic procedures, balloon mitral valvuloplasty (BMV) using the Inoue technique gained popularity and currently is the procedure of choice for treatment of rheumatic MS in patients with favorable valve anatomy.² In these patients long-term outcome is favorable, with excellent survival rates without functional disability or need for repeat intervention.^3,4 By contrast, the results of BMV in those with adverse valve morphology are less predictable.^5–8

Selection of an appropriately sized balloon catheter for a safe stepwise dilation procedure is of paramount importance in order to avoid iatrogenic severe mitral regurgitation (MR) during BMV. Various criteria have been proposed for ideal balloon sizing, depending on the patient's height,^9,10 body surface area (BSA), and mitral annulus size.^11–13

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