[Percutaneous mitral valvuloplasty]

Pure mitral stenosis has a bad prognosis due to progressive narrowing of the mitral orifice, which requires surgical techniques to widen it. Among these procedures are open heart surgery and the percutaneous approach through balloon valvuloplasty. This article is an update of the indications and on the use of echocardiography for patient selection. It describes transeptal puncture and analyses the advantages and disadvantages of the different interventional techniques with: one balloon, emphasizing on a technique modified by us, i.e., th use of Nucleus balloon; with Inoue balloon, double balloon technique, and Cribier's valvulotomy, which is not performed in our country because no valvulotome is currently available. We analyze the success rate, which is of 100% when considering any increase in valvular area and of 61% in unfavorable patients, taking as a success parameter a 50% increase in the original valvular area and a decrease of the transvalvular gradient to less than 10 mm Hg. We comment about procedure complications, such as severe valvular regurgitation, interatrial shunt and tamponade. Procedure mortality is of 1%, especially when the valvular area is small-es than 0.7 cm2 or the Wilkins score is over 13.