Balloon mitral valvulotomy as a bridge to valve replacement.

: Balloon mitral valvulotomy is used in treating mitral stenosis. We stabilized a near-moribund patient who had combined aortic and mitral valve stenoses with this technique on an emergency basis. Following valvulotomy, mitral valve area increased from 1.1 to 2.2 cm2, pulmonary capillary wedge pressure decreased from 31 to 21 mmHg, and cardiac index increased from 1.9 to 2.8 L/min/m2. When the patient's condition improved, we replaced the aortic and mitral valves with St. Jude Medical bileaflet prostheses. Balloon mitral valvulotomy has not been previously described as a "bridge" to operation. The patient in this report was at extremely high risk with cardiopulmonary and hepatorenal failure, and is the first where valvulotomy was used as temporary rather than definitive management. It should be considered only in cases without calcified, fibrotic valves and where the operative risk is considered prohibitive.