Mitral stenosis. Evaluation and guidance of valvuloplasty by transesophageal echocardiography.

Percutaneous transvenous balloon mitral valvuloplasty is a well-established alternative to surgical commissurotomy for selected symptomatic patients with rheumatic mitral stenosis. This procedure normally is performed with fluoroscopic guidance; however, even the experienced operator can be misled by radiographic landmarks. The addition of on-line TEE during PBMV facilitates the success and safety of this procedure by guiding the transseptal puncture and the positioning of the dilating balloon catheters across the stenotic mitral valve. In addition to guiding the manipulation of catheters, on-line TEE is also useful for confirming the efficacy of valvuloplasty and for detecting complications. TEE during PBMV is feasible, safe, and well-tolerated by awake patients.