What is the initial step in performing a valvuloplasty with an Inoue balloon?

What is the initial step in performing a valvuloplasty with an Inoue balloon?

• A. Trans-septal access of the left atrium
• B. Guidewire deflected across the valve
• C. Tip of the Inoue balloon inflated and guided across the mitral valve
• D. Front half of balloon inflated within the LV and pulled back to mitral valve orifice

Answer: (A)

Gaining access to the left atrium via a trans-septal puncture is the first step because the Inoue balloon valvotomy is performed from a venous route. You start from the femoral vein, enter the right atrium, and must cross the interatrial septum into the left atrium to reach the mitral valve. Once left atrial access is established, a guidewire is crossed across the mitral valve into the left ventricle, the balloon catheter is then advanced over the wire into the LV and across the mitral valve for dilation. Without creating the septal passage, you cannot reach the left-sided heart structures from a venous approach, so this initial trans-septal access is essential. The other steps—deflecting a guidewire across the valve, inflating the balloon tip to cross the valve, or inflating the front half of the balloon within the LV and pulling back—occur after left atrial access and crossing the mitral valve.

Gaining access to the left atrium via a trans-septal puncture is the first step because the Inoue balloon valvotomy is performed from a venous route. You start from the femoral vein, enter the right atrium, and must cross the interatrial septum into the left atrium to reach the mitral valve. Once left atrial access is established, a guidewire is crossed across the mitral valve into the left ventricle, the balloon catheter is then advanced over the wire into the LV and across the mitral valve for dilation. Without creating the septal passage, you cannot reach the left-sided heart structures from a venous approach, so this initial trans-septal access is essential.

The other steps—deflecting a guidewire across the valve, inflating the balloon tip to cross the valve, or inflating the front half of the balloon within the LV and pulling back—occur after left atrial access and crossing the mitral valve.