Percutaneous balloon mitral commissurotomy using the Inoue balloon. This device is a modification of a simple cylindrical balloon, waisted to hold its position in the stenotic mitral orifice (1). Using transseptal access, as seen here, the balloon is positioned across the orifice and expanded until an adequate mitral orifice is created with a minimum of regurgitation. The procedure is usually done under fluoroscopic guidance, but may be done under TEE or intracardiac echocardiographic guidance (2). It is especially useful in young, pliable valves (3) and during pregnancy (4). Early results predict late results (5).

(Figure from Iung, B., and Vahanian, A. Echocardiography in the patient undergoing catheter balloon mitral valvuloplasty: patient selection, hemodynamic results, complications, and long term outcome. In Otto CM, ed. The practice of clinical echocardiography [3. ed]. p. 486 ©Elsevier, 2007)

1. Shaw TR, Turnbull CM, Currie P, Flapan AD, Pringle S, Lee BC. A comparison of cylindrical and Inoue balloon techniques for mitral valvotomy in patients in the United Kingdom. Br Heart J 1994;72(5): 486–491.
2. Gupta S, Schiele F, Xu C, Meneveau N, Seronde M-F, Breton V, Bernard Y, Bassand J-P. Simplified percutaneous mitral valvuloplasty with the Inoue balloon. Eur Heart J 1998;19(4):610-616.
3. Gamra H, Betbout F, Ben Hamda K, Addad F, Maatouk F, Dridi Z, Hammami S, Abdellaoui M, Boughanmi H, Hendiri T, Ben Farhat M. Balloon mitral commissurotomy in juvenile rheumatic mitral stenosis: a ten-year clinical and echocardiographic actuarial results. Eur Heart J 2003;24(14): 1349-1356.
4. Ben Farhat M, Gamra H, Betbout F, Maatouk F, Jarrar M, Addad F, Tiss M, Hammami S, Chahbani I, Thaalbi R. Percutaneous balloon mitral commissurotomy during pregnancy. Heart 1997;77(6): 564–567.
5. Vahanian A, Iung B, Cormier B, Makita Y, Luxereau P. Long-term results after percutaneous balloon mitral commissurotomy. J Interv Cardiol 2007;13(4): 281-285.