Cardiovascular Journal of Africa: Vol 27 No 3 (May/June 2016)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016

150

AFRICA

Although there are many data for MBV, there is no consensus

in determining the optimal size of the balloon.

Appropriate

balloon catheter sizing is the most important step for successful

MBV procedure, as well as in reducing complications.

Routine

balloon sizing based on the conventional height-based formula

has been validated in many studies.

However, empirical

selection of balloon size by the height-based formula has no

correlation with variables such as cardiac structure, MVA and

orifice. This mismatch can prevent the success of the process

required and can lead to inappropriate consequences, even

though perfect procedures are carried out by trained surgeons.

Also, the relationship of a person’s height to the diameter of

the mitral valve orifice is not necessarily linear.

As a result of

these findings, more effective methods have been investigated

to determine the appropriate size of the balloon to maximise

success and efficiency and to minimise complication rates.

Nobuyoshi and colleagues recommended selecting the

balloon size by directly measuring the mitral annular diameter

using two-dimensional echocardiography to avoid undesirable

extensive injury to the mitral valve apparatus.

When maximal

diastolic annulus diameter is used for balloon sizing, the balloon

reference sizes are smaller than those obtained with the height-

based formula.

In this way, balloons with a smaller diameter

can be used to achieve sufficient mitral valve area, and with

smaller balloons, procedures might be performed with less

damage to the chordal structure and the leaflets. Less damage to

the mitral valve apparatus results in less MR.

In our study we have shown that selecting Inoue balloon size

according to echocardiographic maximal diastolic diameter is as

efficient as using the height-based formula. Final balloon sizes

were similar between the HBRS and EBRS groups but were

smaller in the EBRS group. There was a significant difference

between calculated and final balloon sizes in the HBRS group. We

achieved sufficient MVAs by echocardiography-derived balloon

sizing in this study, associated with lesser degrees of MR change.

Sanati and colleagues had the same clinical results with the

EBRS method. Their final balloon sizes were similar between

the two groups, and they achieved better valve areas with less

MR.

We believe that if calculated and final balloon sizes are

similar, the success of MBV will be higher. Using the correct size

of balloon and inflation pressure will cause less damage to the

mitral valve apparatus.

Considering the fact that severe MR is also infrequent with

the height-based method, but in our study severe MR was

seen less in the EBRS group, we believe that applying invasive

treatments for heart diseases using imaging methods could be

better than using empirical methods. So in order to achieve

effective MVA without severe MR, we suggest the EBRS method

to select Inoue balloon size. In the future, the importance and

correlation of MR developing after MBV with prognosis of

patients will be better understood.

Study limitations

The participants in this study were all suitable for MBV, and we

did not include patients who had a borderline Wilkins score. The

number of patients in our study was higher than in other studies

in the literature; however, the number of patients should perhaps

have been greater. Also, long-term follow-up results, especially

those concerning MR, are yet to be published.

Conclusion

EBRS is a method that is independent of body structure. Some

patients are tall, some are short, and some are obese or asthenic,

so patients who have discordance between heart size and body

structure may benefit from this method. Choosing Inoue balloon

size for BMV by measuring maximal diastolic annulus diameter

using echocardiography is a reasonable method with acceptable

final MVAs to avoid the risk of significant MR.

Echocardiographic balloon sizing for BMV should be used,

especially in patients with discordance between height and heart

size. We believe that all types of invasive procedures may be

planned according to the dimensions of cardiac structures. Our

study sheds some light on this issue.

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