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Between August 1987 and November 1988, combined mitral and aortic balloon valvuloplasty was performed in 10 patients (mean age 42 ± 9 years), all of whom had symptomatic mitral and aortic stenosis, the procedure was performed using a transarterial approach with a multiballoon catheter and an exteriorized intracardiac long guidewire circuit. The procedure could be considered successful in 9 patients where significant increases in the mean mitral (0.97 ± 0.19 to 1.80 ± 0.26 cm 2 ) and aortic (0.63 ± 0.18 to 1.15 ± 0.32 cm 2 ) areas were achieved. Severe mitral regurgitation that required surgery developed in 1 patient in the following 24 hours. Femoral vascular surgery was necessary in 1 patient. Mid-term follow-up was available in 8 patients for a period averaging 8 ± 3 months. The 9 patients in whom the procedure was successful showed persistent clinical improvement in functional class- Doppler echocardiography showed 2 cases of aortk restenosis and none of mitral restenosis. Combined mitral and aortic balloon valvuloplasty could be a valid alternative treatment in selected patients with both mitral and aortic rheumatic stenosis. Further experience and longterm hemodynamic follow-up are necessary to define the role of this mode of treatment.

To minimize vascular damage in percutaneous balloon valvuloplasty, a new type of dynamic adjustable vascular introducer has been developed which is capable of both expanding and contracting on the passage of a balloon catheter. This ability greatly reduces damage to the vessel and limits blood loss at the site of entry during the procedure. It has been used in both mitral and aortic balloon valvuloplasty.

Balloon valvuloplasty was used in the operating room on 7 patients to visually assess the valvular changes induced by inflation of a balloon catheter. All patients had typical pulmonary valve stenosis and an associated cardiac condition which necessitated surgery. Of 23 fused commissures present, 21 were successfully opened with a single balloon inflation. In 2 patients, damage to the leaflets was observed. In 1 patient there was partial detachment and in the other a small tear was noted at the margin of one leaflet. These intraoperative results may be similar to the results obtained with percutaneous balloon valvuloplasty.