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October 13, 1993, Vol 270, No. 14 >
ARTICLE | October 13, 1993

Percutaneous Mitral Balloon Valvotomy and the New Demographics of Mitral Stenosis FREE

John D. Carroll, MD; Ted Feldman, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to University of Chicago Hospital, 5841 S Maryland Ave, MC 5076, Chicago, IL 60637 (Dr Carroll).


JAMA. 1993;270(14):1731-1736. doi:10.1001/jama.1993.03510140091035
Text Size: A A A
Published online
Article
References

Objective.  —This review discusses the latest developments in selected clinical features and catheter-based therapy of mitral stenosis.

Data Sources.  —English-language journal articles and reviews in the clinical and epidemiological literature as related to mitral valve stenosis from 1965 through March 1993, identified by bibliography review and expert consultation.

Study Selection.  —Selected studies included clinical trials with adequate patient population description and short- and long-term (5 years) follow-up for topics related to mitral valve stenosis in the clinical literature.

Data Extraction.  —Two reviewers participated in extracting the data with the aim of presenting a balanced and comprehensive review of the subject.

Data Synthesis and Conclusions.  —The main conclusions are (1) mitral stenosis should no longer be viewed as a largely "geriatric disease" in the United States due to a recent inflow many young immigrants from countries where rheumatic fever continues partially or wholly unabated; (2) clinical and anatomical features of mitral stenosis are age-dependent; when clinical presentation occurs at 30 vs 70 years of age, for example, the degree of valve obstruction may be similar but differences exist in the frequency of atrial fibrillation, the magnitude of reduction in cardiac output, the degree of valve deformity and calcification, and the frequency of coexistent coronary artery disease; and (3) mitral stenosis therapy has undergone a reorientation with the introduction of percutaneous mitral balloon valvotomy, which has proven to be safe, cost-effective, and to provide short- and long-term improvements in symptomatic and hemodynamic status in selected patients.(JAMA. 1993;270:1731-1736)

REFERENCES

1 +
US Immigration and Naturalization Service. Statistical Yearbook of the Immigration and Naturalization Service, 1990 . Washington, DC: US Immigration and Naturalization Service; 1991;.
2 +
Dodu SRA, Bothig S.  Rheumatic fever and rheumatic heart disease in developing countries. World Health Forum . 1989;;10:203-212.
3 +
Agarwal BL.  Rheumatic heart disease unabated in developing countries. Lancet . 1981;;2:910-911.
4 +
World Health Organization Study Group. Rheumatic Fever and Rheumatic Heart Disease . Geneva, Switzerland: World Health Organization; 1988;. Technical Report Series 764.
5 +
Bisno A.  The rise and fall of rheumatic fever. JAMA . 1985;;254:538-541.
6 +
Stollerman GH.  Rheumatic fever and other rheumatic disease of the heart.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 4th ed. Philadelphia, Pa: WB Saunders Co; 1992;: 1721-1731.
7 +
Strasser T, Dondog N, Elkholy A, et al.  The community control of rheumatic fever and rheumatic heart disease: report of a WHO international cooperative project. Bull World Health Organ . 1981;;59: 285-294.
8 +
 Community control of rheumatic heart disease in developing countries: a major public health problem. WHO Chron . 1990;;34:336-345.
9 +
Feldman T, Carroll JD, Herrmann HC, et al.  Effect of balloon size and stepwise inflation technique on the acute results of Inoue mitral commissurotomy. Cathet Cardiovasc Diagn . 1993;;28:199-205.
10 +
Homer C, Shulman ST.  Clinical aspects of acute rheumatic fever. J Rheumatol . 1991;;18( (suppl 29) ):2-13.
11 +
Odio A.  The incidence of acute rheumatic fever in a suburban area of Los Angeles. West J Med . 1986;;144:179-184.
12 +
Centers for Disease Control.  Acute rheumatic fever—Utah. MMWR Morb Mortal Wkly Rep . 1987;; 36:108-115.
13 +
Centers for Disease Control.  Acute rheumatic fever at Navy training center, San Diego, CA. MMWR Morb Mortal Wkly Rep . 1988;;37:101-104.
14 +
Veasy LG, Wiedmeier SE, Orsmond GS, et al.  Resurgence of acute rheumatic fever in the inter-mountain area of the United States. N Engl J Med . 1987;;316:421-427.
15 +
Centers for Disease Control.  Acute rheumatic fever among Army trainees—Fort Leonard Wood, MO, 1987-1988. MMWR Morb Mortal Wkly Rep . 1988;;34:519-523.
16 +
Stollerman GH.  Rheumatogenic group A streptococci and the return of rheumatic fever. Adv Intern Med . 1990;;35:1-26.
17 +
Zabriskie JB.  Rheumatic fever: the interplay between host, genetics, and microbe. Circulation . 1985;; 71:1077-1086.
18 +
United Kingdom and United States Joint Report on Rheumatic Heart Disease.  The natural history of rheumatic fever and rheumatic heart disease: tenyear report of a cooperative clinical trial of ACTH, cortisone, and aspirin. Circulation . 1965;;32:457-471.
19 +
Cohen DJ, Kuntz RE, Gordon SPF, et al.  Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty. N Engl J Med . 1992;;327: 1329-1335.
20 +
Feldman T, Carroll JD, Isner JM, et al.  Effect of valve deformity on results and mitral regurgitation after Inoue balloon commissurotomy. Circulation . 1992;;85:180-187.
21 +
Palacios I, Block PC, Brandi S, et al.  Percutaneous balloon valvotomy for patients with severe mitral stenosis. Circulation . 1987;;75:778-784.
22 +
Vahanian A, Michel PL, Cormier B, et al.  Results of percutaneous mitral commissurotomy in 200 patients. Am J Cardiol . 1989;;63:847-852.
23 +
Babic U, Pejcic P, Djurisic Z, Vucinic M, Grujicic SM.  Percutaneous transarterial balloon valvuloplasty for mitral valve stenosis. Am J Cardiol . 1986;;57: 1101-1104.
24 +
Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N.  Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg . 1984;;87:394-402.
25 +
Nobuyoshi M, Hamasaki N, Kimura T, et al.  Indications, complications, and short-term clinical outcome of percutaneous transvenous mitral commissurotomy. Circulation . 1989;;80:782-792.
26 +
Chen CR, Hu SW, Chen JY, et al.  Percutaneous mitral valvuloplasty with a single rubber-nylon balloon (Inoue balloon): long-term results in 71 patients. Am Heart J . 1990;;120:561-568.
27 +
Al Zaibag M, Al Kasab S, Ribeiro PA, Al-Fagih MR.  Percutaneous double-balloon mitral valvotomy for rheumatic mitral valve stenosis. Lancet . 1986;;1: 757-761.
28 +
Patel JJ, Shama D, Mitha AS, et al.  Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol . 1991;;18:1318-1322.
29 +
Park SJ, Lee SJK, Kim JJ, Park SW, Seong IW.  Percutaneous mitral balloon valvotomy using Inoue and double balloon technique (randomized trial). J Am Coll Cardiol . 1991;;17:340A.
30 +
Essop MR, Wisenbaugh T, Skoularigis J, Middlemost S, Sareli P.  Mitral regurgitation following mitral balloon valvotomy. Circulation . 1991;;84:1669-1679.
31 +
Braunwald E.  Valvular heart disease.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 4th ed. Philadelphia, Pa: WB Saunders Co; 1992;:1007-1077.
32 +
Waller BF.  Rheumatic and nonrheumatic conditions producing valvular heart disease.  In: Frankl WS, Brest AN, eds. Cardiovascular Clinics: Valvular Heart Disease: Comprehensive Evaluation and Management . Philadelphia, Pa: FA Davis; 1986;:3-104.
33 +
Abbo K, Carroll JD, Feldman T, Herrmann HC, and the North American Inoue Investigators.  The impact of age on the hemodynamic features of mitral stenosis. Clin Res . 1992;;40:682A.
34 +
Mattina CJ, Green SJ, Tortolani AJ, et al.  Frequency of angiographically significant coronary arterial narrowing in mitral stenosis. Am J Cardiol . 1986;;57:802-805.
35 +
Sherrid M, Goyal A, Delia E, et al.  Unsuspected mitral stenosis. Am J Med . 1991;;90:189-192.
36 +
John S, Bashi VV, Jairaj PS, et al.  Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients. Circulation . 1983;;68:891-898.
37 +
Bashore TM, Davidson CJ, and the  Mansfield Scientific Aortic Valvuloplasty Registry Investigators. Follow-up recatheterization after balloon aortic valvuloplasty. J Am Coll Cardiol . 1991;;17:1188-1196.
38 +
Kawanishi DT, Rahimtoola SH.  Catheter balloon commissurotomy for mitral stenosis: complications and results. J Am Coll Cardiol . 1992;;19:192-195.
39 +
Lock JE, Khalilullah M, Shrivastava S, Bahl V, Keane JF.  Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med . 1985;; 313:1515-1518.
40 +
Inoue K, Feldman T.  Percutaneous transvenous mitral commissurotomy using the Inoue balloon catheter. Cathet Cardiovasc Diagn . 1993;;28:119-125.
41 +
Inoue K, Hung J-S, Chen C-R, Cheng TO.  Mitral stenosis: Inoue balloon catheter technique.  In: Cheng TO, ed. Percutaneous Balloon Valvuloplasty . New York, NY: Iqaki-Shion; 1992;:237-284.
42 +
Palacios IF, Lock JE, Keane JF, Block PC.  Percutaneous transvenous balloon valvotomy in a patient with severe calcific mitral stenosis. J Am Coll Cardiol . 1986;;7:1416-1419.
43 +
McKay RG, Lock JE, Keane JF, Safian RD, Aroesty JM, Grossman W.  Percutaneous mitral valvuloplasty in an adult patient with calcific rheumatic mitral stenosis. J Am Coll Cardiol . 1986;;7:1410-1415.
44 +
Al Kasab S, Ribeiro PA, Al Zaibag M, et al.  Comparison of results of percutaneous balloon mitral valvotomy using single and double balloon techniques. Am J Cardiol . 1986;;63:135-136.
45 +
Feldman T, Carroll JD.  Valve deformity and balloon mechanics in percutaneous transvenous mitral commissurotomy. Am Heart J . 1991;;121:1628-1633.
46 +
The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry Participants.  Multi-center experience with balloon mitral commissurotomy: NHLBI balloon valvuloplasty registry report on immediate and 30-day follow-up results. Circulation . 1992;;85:448-461.
47 +
McKay CR, Kawanishi DT, Rahimtoola SH.  Catheter balloon valvuloplasty of the mitral valve in adults using a double-balloon technique. JAMA . 1987;;257: 1753-1761.
48 +
Ruiz CE, Allen JW, Lau FYK.  Percutaneous double balloon valvotomy for severe rheumatic mitral stenosis. Am J Cardiol . 1990;;65:473-477.
49 +
Levine MJ, Weinstein JS, Diver DJ, et al.  Progressive improvement in pulmonary vascular resistance after percutaneous mitral valvuloplasty. Circulation . 1989;;79:1061-1067.
50 +
Khuri SF, Folland ED, Sethi GK, et al.  Six-month postoperative hemodynamics of the Hancock heterograft and the Bjork-Shiley prosthesis: results of a Veterans Administration cooperative prospective randomized trial. J Am Coll Cardiol . 1988;;12:8-18.
51 +
Hung JS, Chern MS, Wu JJ, et al.  Short and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy. Am J Cardiol . 1991;;67:854-862.
52 +
Palacios IF, Block PC, Wilkins GT, Weyman AE.  Follow-up of patients undergoing percutaneous mitral balloon valvotomy: analysis of factors determining restenosis. Circulation . 1989;;79:573-579.
53 +
Tuzcu EM, Block PC, Griffin BP, Newell JB, Palacios IF.  Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 years and older. Circulation . 1992;;85:963-971.
54 +
Chen T-Z, Chen J-Y, Zhou Y-L, Mei J, Ma T-Z, Cheng TO.  Long-term results of percutaneous balloon mitral valvuloplasty by Inoue balloon catheter technique. J Am Coll Cardiol . 1992;;19:143A.
55 +
Turi ZG, Reyes VP, Raju BS, et al.  Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis: a prospective, randomized trial. Circulation . 1991;;83:1179-1185.
56 +
Yoshida K, Yoshikawa J, Akasaka T, et al.  Assessment of left-to-right shunting after percutaneous mitral valvuloplasty by transesophageal color Doppler flow mapping. Circulation . 1989;;8:1521-1526.
57 +
 A Report From the National Heart, Lung and Blood Institute. Balloon valvuloplasty registry: complications and mortality of percutaneous balloon mitral commissurotomy. Circulation . 1992;;85:2014-2024.
58 +
Fatkin D, Roy P, Morgan JJ, Feneley MP.  Percutaneous balloon mitral valvotomy with the Inoue single-balloon catheter: commissural morphology as a determinant of outcome. J Am Coll Cardiol . 1993;; 21:390-397.
59 +
Casale PN, Whitlow P, Currie PJ, Stewart WJ.  Transesophageal echocardiography in percutaneous balloon valvuloplasty for mitral stenosis. Cleve Clin J Med . 1989;;56:597-600.
60 +
Kronzon I, Tunick PA, Schwinger ME, Slater J, Glassman E.  Transesophageal echocardiography during percutaneous mitral valvuloplasty. J Am Soc Echocardiogr . 1989;;2:380-385.
61 +
Hung JS, Lin FC, Chiang CW.  Successful percutaneous transvenous catheter balloon mitral commissurotomy after warfarin therapy and resolution of left atrial thrombus. Am J Cardiol . 1989;;64:126-128.
62 +
Feldman T, Carroll JD.  Cardiac catheterization, balloon angioplasty and percutaneous valvuloplasty . In: Wood LDH, Hall J, Schmidt G, eds. Principles of Critical Care Medicine . York, Pa: McGraw-Hill International Book Co; 1992;:343-360.
63 +
Bernard Y, Bassand JP, Schiele F, et al.  Percutaneous mitral valvulotomy in non-optimal candidates. Eur Heart J . 1991;;12( (suppl B) ):90-94.
64 +
Esteves CA, Ramos AIO, Braga SLN, Harrison JK, Sousa JEMR.  Effectiveness of percutaneous balloon mitral valvotomy during pregnancy. Am J Cardiol . 1991;;68:930-934.
65 +
Gangbar EW, Watson KR, Howard RJ, Chisholm RJ.  Mitral balloon valvuloplasty in pregnancy: advantages of a unique balloon. Cathet Cardiovasc Diagn . 1992;;25:313-316.
66 +
Ribeiro PA, Fawzy ME, Awad M, Dunn B, Duran CG.  Balloon valvotomy for pregnant patients with severe pliable mitral stenosis using the Inoue technique with total abdominal and pelvic shielding. J Am Coll Cardiol . 1992;;19:143A.
67 +
Medina A, Suarez De Lezo J, Hernandez E, et al.  Balloon valvuloplasty for mitral restenosis after previous surgery: a comparative study. Am Heart J . 1990;;120:568-573.
68 +
Attubato MJ, Stroh JA, Bach RG, Slater J, Feit F.  Percutaneous double-balloon valvuloplasty of porcine bioprosthetic valves in the tricuspid position. Cathet Cardiovasc Diagn . 1990;;20:202-204.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
US Immigration and Naturalization Service. Statistical Yearbook of the Immigration and Naturalization Service, 1990 . Washington, DC: US Immigration and Naturalization Service; 1991;.
2 +
Dodu SRA, Bothig S.  Rheumatic fever and rheumatic heart disease in developing countries. World Health Forum . 1989;;10:203-212.
3 +
Agarwal BL.  Rheumatic heart disease unabated in developing countries. Lancet . 1981;;2:910-911.
4 +
World Health Organization Study Group. Rheumatic Fever and Rheumatic Heart Disease . Geneva, Switzerland: World Health Organization; 1988;. Technical Report Series 764.
5 +
Bisno A.  The rise and fall of rheumatic fever. JAMA . 1985;;254:538-541.
6 +
Stollerman GH.  Rheumatic fever and other rheumatic disease of the heart.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 4th ed. Philadelphia, Pa: WB Saunders Co; 1992;: 1721-1731.
7 +
Strasser T, Dondog N, Elkholy A, et al.  The community control of rheumatic fever and rheumatic heart disease: report of a WHO international cooperative project. Bull World Health Organ . 1981;;59: 285-294.
8 +
 Community control of rheumatic heart disease in developing countries: a major public health problem. WHO Chron . 1990;;34:336-345.
9 +
Feldman T, Carroll JD, Herrmann HC, et al.  Effect of balloon size and stepwise inflation technique on the acute results of Inoue mitral commissurotomy. Cathet Cardiovasc Diagn . 1993;;28:199-205.
10 +
Homer C, Shulman ST.  Clinical aspects of acute rheumatic fever. J Rheumatol . 1991;;18( (suppl 29) ):2-13.
11 +
Odio A.  The incidence of acute rheumatic fever in a suburban area of Los Angeles. West J Med . 1986;;144:179-184.
12 +
Centers for Disease Control.  Acute rheumatic fever—Utah. MMWR Morb Mortal Wkly Rep . 1987;; 36:108-115.
13 +
Centers for Disease Control.  Acute rheumatic fever at Navy training center, San Diego, CA. MMWR Morb Mortal Wkly Rep . 1988;;37:101-104.
14 +
Veasy LG, Wiedmeier SE, Orsmond GS, et al.  Resurgence of acute rheumatic fever in the inter-mountain area of the United States. N Engl J Med . 1987;;316:421-427.
15 +
Centers for Disease Control.  Acute rheumatic fever among Army trainees—Fort Leonard Wood, MO, 1987-1988. MMWR Morb Mortal Wkly Rep . 1988;;34:519-523.
16 +
Stollerman GH.  Rheumatogenic group A streptococci and the return of rheumatic fever. Adv Intern Med . 1990;;35:1-26.
17 +
Zabriskie JB.  Rheumatic fever: the interplay between host, genetics, and microbe. Circulation . 1985;; 71:1077-1086.
18 +
United Kingdom and United States Joint Report on Rheumatic Heart Disease.  The natural history of rheumatic fever and rheumatic heart disease: tenyear report of a cooperative clinical trial of ACTH, cortisone, and aspirin. Circulation . 1965;;32:457-471.
19 +
Cohen DJ, Kuntz RE, Gordon SPF, et al.  Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty. N Engl J Med . 1992;;327: 1329-1335.
20 +
Feldman T, Carroll JD, Isner JM, et al.  Effect of valve deformity on results and mitral regurgitation after Inoue balloon commissurotomy. Circulation . 1992;;85:180-187.
21 +
Palacios I, Block PC, Brandi S, et al.  Percutaneous balloon valvotomy for patients with severe mitral stenosis. Circulation . 1987;;75:778-784.
22 +
Vahanian A, Michel PL, Cormier B, et al.  Results of percutaneous mitral commissurotomy in 200 patients. Am J Cardiol . 1989;;63:847-852.
23 +
Babic U, Pejcic P, Djurisic Z, Vucinic M, Grujicic SM.  Percutaneous transarterial balloon valvuloplasty for mitral valve stenosis. Am J Cardiol . 1986;;57: 1101-1104.
24 +
Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N.  Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg . 1984;;87:394-402.
25 +
Nobuyoshi M, Hamasaki N, Kimura T, et al.  Indications, complications, and short-term clinical outcome of percutaneous transvenous mitral commissurotomy. Circulation . 1989;;80:782-792.
26 +
Chen CR, Hu SW, Chen JY, et al.  Percutaneous mitral valvuloplasty with a single rubber-nylon balloon (Inoue balloon): long-term results in 71 patients. Am Heart J . 1990;;120:561-568.
27 +
Al Zaibag M, Al Kasab S, Ribeiro PA, Al-Fagih MR.  Percutaneous double-balloon mitral valvotomy for rheumatic mitral valve stenosis. Lancet . 1986;;1: 757-761.
28 +
Patel JJ, Shama D, Mitha AS, et al.  Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol . 1991;;18:1318-1322.
29 +
Park SJ, Lee SJK, Kim JJ, Park SW, Seong IW.  Percutaneous mitral balloon valvotomy using Inoue and double balloon technique (randomized trial). J Am Coll Cardiol . 1991;;17:340A.
30 +
Essop MR, Wisenbaugh T, Skoularigis J, Middlemost S, Sareli P.  Mitral regurgitation following mitral balloon valvotomy. Circulation . 1991;;84:1669-1679.
31 +
Braunwald E.  Valvular heart disease.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 4th ed. Philadelphia, Pa: WB Saunders Co; 1992;:1007-1077.
32 +
Waller BF.  Rheumatic and nonrheumatic conditions producing valvular heart disease.  In: Frankl WS, Brest AN, eds. Cardiovascular Clinics: Valvular Heart Disease: Comprehensive Evaluation and Management . Philadelphia, Pa: FA Davis; 1986;:3-104.
33 +
Abbo K, Carroll JD, Feldman T, Herrmann HC, and the North American Inoue Investigators.  The impact of age on the hemodynamic features of mitral stenosis. Clin Res . 1992;;40:682A.
34 +
Mattina CJ, Green SJ, Tortolani AJ, et al.  Frequency of angiographically significant coronary arterial narrowing in mitral stenosis. Am J Cardiol . 1986;;57:802-805.
35 +
Sherrid M, Goyal A, Delia E, et al.  Unsuspected mitral stenosis. Am J Med . 1991;;90:189-192.
36 +
John S, Bashi VV, Jairaj PS, et al.  Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients. Circulation . 1983;;68:891-898.
37 +
Bashore TM, Davidson CJ, and the  Mansfield Scientific Aortic Valvuloplasty Registry Investigators. Follow-up recatheterization after balloon aortic valvuloplasty. J Am Coll Cardiol . 1991;;17:1188-1196.
38 +
Kawanishi DT, Rahimtoola SH.  Catheter balloon commissurotomy for mitral stenosis: complications and results. J Am Coll Cardiol . 1992;;19:192-195.
39 +
Lock JE, Khalilullah M, Shrivastava S, Bahl V, Keane JF.  Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med . 1985;; 313:1515-1518.
40 +
Inoue K, Feldman T.  Percutaneous transvenous mitral commissurotomy using the Inoue balloon catheter. Cathet Cardiovasc Diagn . 1993;;28:119-125.
41 +
Inoue K, Hung J-S, Chen C-R, Cheng TO.  Mitral stenosis: Inoue balloon catheter technique.  In: Cheng TO, ed. Percutaneous Balloon Valvuloplasty . New York, NY: Iqaki-Shion; 1992;:237-284.
42 +
Palacios IF, Lock JE, Keane JF, Block PC.  Percutaneous transvenous balloon valvotomy in a patient with severe calcific mitral stenosis. J Am Coll Cardiol . 1986;;7:1416-1419.
43 +
McKay RG, Lock JE, Keane JF, Safian RD, Aroesty JM, Grossman W.  Percutaneous mitral valvuloplasty in an adult patient with calcific rheumatic mitral stenosis. J Am Coll Cardiol . 1986;;7:1410-1415.
44 +
Al Kasab S, Ribeiro PA, Al Zaibag M, et al.  Comparison of results of percutaneous balloon mitral valvotomy using single and double balloon techniques. Am J Cardiol . 1986;;63:135-136.
45 +
Feldman T, Carroll JD.  Valve deformity and balloon mechanics in percutaneous transvenous mitral commissurotomy. Am Heart J . 1991;;121:1628-1633.
46 +
The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry Participants.  Multi-center experience with balloon mitral commissurotomy: NHLBI balloon valvuloplasty registry report on immediate and 30-day follow-up results. Circulation . 1992;;85:448-461.
47 +
McKay CR, Kawanishi DT, Rahimtoola SH.  Catheter balloon valvuloplasty of the mitral valve in adults using a double-balloon technique. JAMA . 1987;;257: 1753-1761.
48 +
Ruiz CE, Allen JW, Lau FYK.  Percutaneous double balloon valvotomy for severe rheumatic mitral stenosis. Am J Cardiol . 1990;;65:473-477.
49 +
Levine MJ, Weinstein JS, Diver DJ, et al.  Progressive improvement in pulmonary vascular resistance after percutaneous mitral valvuloplasty. Circulation . 1989;;79:1061-1067.
50 +
Khuri SF, Folland ED, Sethi GK, et al.  Six-month postoperative hemodynamics of the Hancock heterograft and the Bjork-Shiley prosthesis: results of a Veterans Administration cooperative prospective randomized trial. J Am Coll Cardiol . 1988;;12:8-18.
51 +
Hung JS, Chern MS, Wu JJ, et al.  Short and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy. Am J Cardiol . 1991;;67:854-862.
52 +
Palacios IF, Block PC, Wilkins GT, Weyman AE.  Follow-up of patients undergoing percutaneous mitral balloon valvotomy: analysis of factors determining restenosis. Circulation . 1989;;79:573-579.
53 +
Tuzcu EM, Block PC, Griffin BP, Newell JB, Palacios IF.  Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 years and older. Circulation . 1992;;85:963-971.
54 +
Chen T-Z, Chen J-Y, Zhou Y-L, Mei J, Ma T-Z, Cheng TO.  Long-term results of percutaneous balloon mitral valvuloplasty by Inoue balloon catheter technique. J Am Coll Cardiol . 1992;;19:143A.
55 +
Turi ZG, Reyes VP, Raju BS, et al.  Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis: a prospective, randomized trial. Circulation . 1991;;83:1179-1185.
56 +
Yoshida K, Yoshikawa J, Akasaka T, et al.  Assessment of left-to-right shunting after percutaneous mitral valvuloplasty by transesophageal color Doppler flow mapping. Circulation . 1989;;8:1521-1526.
57 +
 A Report From the National Heart, Lung and Blood Institute. Balloon valvuloplasty registry: complications and mortality of percutaneous balloon mitral commissurotomy. Circulation . 1992;;85:2014-2024.
58 +
Fatkin D, Roy P, Morgan JJ, Feneley MP.  Percutaneous balloon mitral valvotomy with the Inoue single-balloon catheter: commissural morphology as a determinant of outcome. J Am Coll Cardiol . 1993;; 21:390-397.
59 +
Casale PN, Whitlow P, Currie PJ, Stewart WJ.  Transesophageal echocardiography in percutaneous balloon valvuloplasty for mitral stenosis. Cleve Clin J Med . 1989;;56:597-600.
60 +
Kronzon I, Tunick PA, Schwinger ME, Slater J, Glassman E.  Transesophageal echocardiography during percutaneous mitral valvuloplasty. J Am Soc Echocardiogr . 1989;;2:380-385.
61 +
Hung JS, Lin FC, Chiang CW.  Successful percutaneous transvenous catheter balloon mitral commissurotomy after warfarin therapy and resolution of left atrial thrombus. Am J Cardiol . 1989;;64:126-128.
62 +
Feldman T, Carroll JD.  Cardiac catheterization, balloon angioplasty and percutaneous valvuloplasty . In: Wood LDH, Hall J, Schmidt G, eds. Principles of Critical Care Medicine . York, Pa: McGraw-Hill International Book Co; 1992;:343-360.
63 +
Bernard Y, Bassand JP, Schiele F, et al.  Percutaneous mitral valvulotomy in non-optimal candidates. Eur Heart J . 1991;;12( (suppl B) ):90-94.
64 +
Esteves CA, Ramos AIO, Braga SLN, Harrison JK, Sousa JEMR.  Effectiveness of percutaneous balloon mitral valvotomy during pregnancy. Am J Cardiol . 1991;;68:930-934.
65 +
Gangbar EW, Watson KR, Howard RJ, Chisholm RJ.  Mitral balloon valvuloplasty in pregnancy: advantages of a unique balloon. Cathet Cardiovasc Diagn . 1992;;25:313-316.
66 +
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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