Percutaneous Balloon Mitral Commissurotomy

Percutaneous mitral commissurotomy (PMC) was one of the first catheter-based therapies for structural heart disease and has now become the treatment of choice for selected patients with rheumatic mitral stenosis. Inoue’s single-balloon technique has become the most popular method for performing PMC in most institutions today. The traditional tools of invasive cardiologist (i.e. fluoroscopy and hemodynamic pressure measurement) are inadequate for this procedure, and transoesophageal echocardiography (TEE) has become an essential component. Real time three-dimensional transesophageal echocardiography (RT 3D TEE) has greatly expanded the visualization of mitral stenosis. It provides detailed morphology of leaflets and commissures, and permits accurate planimetry of the valve. It is likely that RT 3D TEE will be used as a primary modality for guiding PMBV in the future. In this chapter we will describe the RT 3D TEE morphology of mitral stenosis, and how RT 3D TEE may add useful information in each stage of the procedure.