Role of echocardiography in mitral commissurotomy with the Inoue balloon

There are well-defined roles for echocardiography in the evaluation of patients with mitral stenosis who undergo percutaneous transvenous mitral commissurotomy. Transthoracic echocardiography is used to assess mitral valve morphology with particular attention to commissural fusion and valve leaflet calcification, the two most important determinants of the severity of mitral stenosis. This assessment has proven to be useful in patient selection, as immediate and long-term outcome can be predicted from echocardiographic grading scores. The degree of mitral regurgitation can also be assessed and has an influence on outcome. The newer technique of transesophageal echocardiography aids in the detection of left atrial thrombi and may be useful in guiding transseptal puncture and in predicting clinical outcomes. Future applications in this ever-expanding field may ultimately include the use of dobutamine stress echocardiography and intravascular ultrasound catheters. It would appear that balloon valvuloplasty and echocardiography are inexorably linked.