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Percutaneous Mitral Balloon Valvotomy-Reply

Ted Feldman, MD; John Carroll, MD
JAMA. 1994;271(8):586. doi:10.1001/jama.1994.03510320026018.
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In Reply.  —Dr Leachman draws attention to the difference in relative costs of closed surgical commissurotomy vs balloon commissurotomy in different countries. We note this point in the text of our article (page 1734, "Hospitalization and Costs").1 Turi et al2 have studied this issue specifically in a population treated in India, where the cost of disposable, nonreusable balloon catheters is relatively high.We do not feel that a return to the practices of the 1950s would advance the treatment of patients with mitral stenosis substantially. Further efforts to develop balloon catheters that can be sold at a lower cost or reused easily might provide a more attractive alternative. We hope also that cost-effectiveness studies will take into account the difference between a thoracotomy and a percutaneous procedure from the patient's perspective.Balloon mitral valvotomy may be performed as easily as closed surgical commissurotomy with adjunctive use of a

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