Tips for balloon mitral valvotomy
Tips for balloon mitral valvotomy: Here are a few tips for balloon mitral valvotomy:
Precautions during balloon dilatation of the mitral valve
First the balloon has to be introduced smoothly upto the apex and should be able to slide back and forth easily. While inflating the distal half of the balloon, if there are multiple indentations, the balloon may be going across the chordae and should not be inflated further. If it is expanding as one part of the dump bell, it can be pulled back to the mitral orifice and further inflation will expand the other half of the dump bell in the left atrium, with the waist of the balloon across the mitral valve. Full inflation of the balloon will produce good dilatation of the mitral valve.
Site of inter atrial septal puncture for balloon mitral valvotomy
Site of puncture is the region of the fossa ovalis, which can be identified as the third forward dip of the Mullin’s sheath while withdrawing from the superior vena cava into the right atrium. It should be midway between parts of the pigtail catheter in the ascending aorta and descending aorta in the transverse plane as seen in RAO view and one space below the pigtail in the vertical plane as seen on LAO view. A lower puncture may be required when the interatrial septum is bulging into the right atrium to have better alignment with with midline of the mitral valve to facilitate easy entry of the balloon into the left ventricle.
Choosing the size of the balloon for balloon mitral valvotomy
Height of the subject in centimeters is divided by 10 and 10 is added to the quotient to get the diameter of the balloon to be used in millimeters. For example, if the height is 150 cm, it will give a balloon diameter of 25 mm [(150/10 = 15) + 10 = 25] for dilatation of the mitral valve.