Simplification of balloon mitral commissurotomy using on-line transesophageal echocardiography

Traditionally balloon mitral commissurotomy (BMC) is performed through left- and right-side cardiac catheterization under the guidance of fluoroscopy and angiography. We and others, however, have proved that the procedure can be successfully carried out under the guidance of fluoroscopy and adjunctive on-line transesophageal echocardiography (TEE) without the need of endotracheal intubation, general anesthesia or angiography. Moreover, since Sept 1998, we began to perform simplified BMC in selected patients using on-line TEE guidance. We omitted the left-side cardiac catheterization. We found that the efficacy and safety of the simplified BMC were similar to those of the sophisticated BMC. Furthermore, it could dramatically reduce the fluoroscopy time, total procedural time and medical cost. We believe that the simplified BMC will become the method of choice in selected patients who need BMC.