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Percutaneous Mitral Balloon Valvotomy

Robert D. Leachman, MD
JAMA. 1994;271(8):586. doi:10.1001/jama.1994.03510320026017.
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To the Editor.  —Drs Carrol1 and Feldman1 state that mitral balloon valvotomy has proven to be safe and cost-effective.I have some question with regard to the cost-effectiveness, since it requires a catheterization laboratory, the installation of which costs an average of $1 million or more. The balloon catheter itself costs several thousand dollars. If, indeed, we are looking for similar palliative therapy, then I believe it would be considerably more cost-effective to return to the practice of the 1950s and 1960s, during which the diagnosis of mitral stenosis was made with a considerable degree of confidence only by auscultation, and many of these patients were successfully treated by closed commissurotomy technique, with similar outcome to that being described for balloon valvuloplasty.In reality, the technique of balloon valvuloplasty is not cost-effective in countries with a low medical budget.


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