Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Percutaneous balloon mitral valvotomy in mitral restenosis
King Edwardard VII Memorial (KEM) Hospital Bombay, India
revised 23 April 1996; accepted 29 April 1996.
Dr Amit Vora. DM. Lecturer, Department of Cardiology, King Edward VII Memonal (KEM) Hospital, Parel, Bombay 12. India.
Abstract
BACKGROUND: Background Mitral restenosis often occurs within 5 to 15 years of surgical valvotomy. Percutaneous balloon mitral valvotomy is well established as a safe and effective alternative to mitral stenosis surgery, but only a few small studies have reported on the procedure.
ALM: (i)To evaluate the safety and efficacy of percutaneous balloon mitral valvotomy in patients with mitral restenosis. (ii) To evaluate the intermediate-term outcome of patients undergoing balloon mitral valvotomy after previous surgical valvotomy. (iii) To compare these patients with those undergoing balloon mitral valvotomy as the initial procedure.
METHODS: We analysed our expenence of 614 consecutive patients undergoing balloon valvotomy and identified 84 patients (137%) with mitral restenosis following prior surgical valvotomy (Group I). The remaining 530 patients (86·3%) had not undergone previous surgery (Group II). The incidence of atrial fibrillation (l9% vs 5·6%), mitral valve calcification (50% vs 30·6%) and total echo score >8 (54·8% vs 24·15%) was significantly higher in Group I. Both groups were comparable as regards their functional class, technique of valvotomy, mitral valve area (0·87 ± 0·18 vs 0·87 ± 0·15 cm2 P=ns), mean transmitral gradient (19·63 ± 6·01 vs 19·21 ± 5·67 mmHg, P=ns), and mean pulmonary artery pressure (42·2 ± 19·0 vs 40·8 ± 14·4 mmHg, P=ns).
RESULTS: Results After percutaneous balloon mitral valvotomy, the final mitral valve area (1·67 ± 0·28 vs 1·69 ± 0·29 cm2 P=ns), mean transmitral-mitral gradient (6·12 ± 3·68 vs 5·02 ± 3·21 mmHg, P=ns) and mean pulmonary artery pressure (31·0 ± 15·2 vs 28·5 ± 11·1 mmHg, P=ns) were comparable. The success rate (93·0% vs 95·3%, P=ns) was similar in both groups. Significant mitral regurgitation was seen in four (4·8%) patients in Group I and 22 (4·1%) patients in Group II (P=ns). There were two deaths (2·4%) in Group I and five (0·9% in Group II (P=ns). The clinical and echo Doppler follow-up (8–40 months) studies showed that both groups were of similar NYHA class, and had similar mitral valve area (1·65 ± 0·21 vs 1·66 ± 0 3 cm2 and transmitral gradients (7·1 ± 3·8 vs 5·9 ± 3·5 mmHg).
CONCLUSIONS: We conclude that percutaneous balloon mitral valvotomy can be performed safely and effectively in patients with mitral restenosis following surgical valvotomy; the beneficial acute outcome is sustained, as shown at intermediate-term follow-up and is similar to that of patients undergoing balloon mitral valvotomy as an initial procedure.
(Eur Heart J 1996; 17: 1560–1564)
Key Words: Rheumatic heart disease • commissurotomy • pulmonary hypertension • intervention
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