Mitral commissurotomy using the Inoue balloon catheter

This is a balloon inflation-deflation sequence during a percutaneous mitral commissurotomy using the Inoue balloon. The balloon catheter has been introduced from the right femoral vein, crosses the interatrial septum after a transseptal catheterization, and has been manipulated across the mitral valve into the left ventricle with the balloon deflated. During inflation, the distal portion of the balloon expands first and the catheter is pulled back slightly with resistance being felt from the stenotic valve. Additional inflation then expands the rear or proximal portion of the balloon, thus locking the balloon within the stenotic valve. The final inflation expands the midportion causing a controlled transmission of force resulting in splitting of the fused commissures. The rapid inflation-deflation sequence shown here results in no important period of hypotension; most patients have little awareness of the inflation. The other catheters seen in the image are a pigtail catheter in the left ventricle and a pulmonary artery thermodilution cardiac output catheter.