BALLOON MITRAL VALVOTOMY OR BMV IN HIGH RISK SUBSETS
Balloon Mitral Valvotomy or BMV is done for patients with mitral stenosis or narrowing of the mitral valve of the heart, which can lead to breathing difficulty on exertion, abnormalities in the heart beat rhythm, clot formation and stroke or paralysis of parts of the body.
Opening of the valve with a Balloon or BMV or PTMC is the treatment of choice. Surgical replacement with a metal valve by Open Heart Surgery is the last treatment option and is done only if a PTMC or BMV are not possible.
The BMV is done via the femoral vein of the leg under simple local anaesthesia and the patient is usually discharged the following day.
However, though the procedure is done under local anaesthesia and though the patient is conscious, the procedure has its inherent risks too, but is safe in the hands of an experienced interventional cardiologist with good experience with PTMC or BMV. The criticality of teh procedure is that it requires a small puncture or home to be made at a precise point in the heart, in the Inter-atrial septum at the fossa-ovalis. Anywhere else can lead to bleeding from the heart, cardiac tamponade, cardiac arrest, need for emergency open heart surgery and a risk of mortality.
The procedure needs more skill when the pressure in the left atrium is very high and the septum is bulged.
This is a patient who had significant septal bulge making septal puncture technically challenging. You can see the steps of femoral venous puncture, septal puncture in AP view, LA wire insertion and successful balloon dilatation. The patients MV area rose from 0.8 to 1.79 cm sq with an excellent relief of symptoms.
DR BINOY JOHN MD DM (CARDIOLOGY) FCSI FACC FESC FSCAI FAPSIC
DIRECTOR AND HEAD: DEPT OF CARDIOLOGY AND INTERVENTIONAL CARDIOLOGY

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