Q. Explain the Technique of Balloon Mitral Valvuloplasty?

The procedure is performed by cannulation of the right femoral vein and the procedure is similar upto transseptal puncture which allows access into the left atrium. Following this the transseptal puncture, a Mullins type dilator and sheath is placed in the left atrium. The patient is anticoagulated with heparin after entry into LA. A coiled guidewire is passes through the Mullins sheath into the left atrium and the mullins sheath is removed. A long dilator is used to dilate the passage into the femoral vein and inter atrial septum. The dilator is removed and the Inoue balloon is threaded over the guidewire and maneuvered into the left atrium. A "J" stylet is inserted into the balloon and manipulated so as to position the Inoue balloon across the mitral valve. The balloon is then inflated - distal portion first, pulled back gently upto the narrowest position of the valve. Then the proximal portion is inflated. Finally the waist of the balloon is inflated to effectively cause commissural splitting.