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This editorial refers to ‘Feasibility of percutaneous mitral commissurotomy in patients with commissural mitral valve calcification’[†][1], by J. Dreyfus et al ., on page 1617Percutaneous balloon mitral valve commissurotomy (PMC) was introduced by Inoue in the 1980s, as an alternative to surgical closed commissurotomy.1 PMC is the first example of a transcatheter valve intervention replicating a surgical procedure, and the fact that Inoue is a surgeon underlines the influence of multidisciplinary efforts in the evolution of transcatheter therapies.Today PMC is the first-line therapy for most symptomatic patients with mitral valve stenosis with favourable clinical and anatomical characteristics (with a recommendation class IB by the latest European guidelines.2 The main objective of PMC is to delay surgery, particularly when this would imply the implantation of a valve prosthesis. In patients not amenable to PMC, in Western countries, closed mitral commissurotomy has been replaced by open mitral commissurotomy using cardiopulmonary bypass in selected patients. Subvalvar apparatus management is the main advantage of open commissurotomy leading to greater valve areas as compared with closed commissurotomy and with PMC in patients with papillo-commissural fusion.3 However, most patients with anatomy not amenable for PMC are also suboptimal candidates for surgical repair and mostly undergo valve replacement.Patient selection plays a key role in PMC, as is the case for other transcatheter interventions. More specifically, anatomical and clinical characteristics are predictive of early and long-term success of the percutaneous procedure. Echocardiography plays a central role in the contemporary decision-making process, and several scores have been developed to predict early and long-term outcomes of PMC.4,5A contemporary focus of the pre-procedural echocardiographic screening for PMC should include a meticulous analysis of the commissures. The commissures are the … [1]: #fn-2

european heart journal

Expanding the indications for percutaneous mitral commmissurotomy in rheumatic mitral stenosis: look carefully at the commissures, and proceed cautiously and skilfully