The presence of a left atrial thrombus increases the complexity and potential complications of percutaneous balloon valvuloplasty of mitral stenosis. During the positioning of the guidewires and/or balloons (or Inoue balloon), the dislodgement of all or part of a left atrial appendage or intracavitary thrombus is a grave possibility. Such an event could lead to a devastating complication, such as stroke, renal or bowel infarction, distal limb arterial occlusion, etc. Patient safety is paramount. Let us not forget the old medical adage, "Do no harm!"
With the advent of transesophageal echocardiography (TEE), percutaneous balloon valvuloplasty can now be a more efficient, successful. and above all safer procedure for the patient. TEE can assist in the more accurate positioning of the transeptal needle, guidewires, and balloon catheter@). TEE can also help evaluate balloon position during inflation, the number of balloon inflations, and the immediate results of the procedure (orifice size, degree of regurgitation, and size of atrial septa1 defect). Finally, if a left atrial thrombus is present, TEE can be used to avoid its displace-ment. We would consider using TEE in most cases of percutaneous balloon valvuloplasty and certainly in all complicated cases. Incidently, the series of patients by Chen et al. [ 11 was not published at the time of our submission, and the article by Chirillo et al. [2] was not known to us.