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European Heart Journal 1996 17(9):1367-1372;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Percutaneous balloon mitral valvuloplasty in patients with mitral restenosis after previous surgical commissurotomy

A matched comparative study

K.-W. Lau, Z.-P. Ding, W. Gao, T.-H Koh and A. Johan

Singapore Heart Centre Singapore

revised 19 January 1996; accepted 29 January 1996.

Correspondence: Kean-Wah Lau, Singapore Heart Centre, Mistri Wing, 3rd Hospital Avenue, Singapore 0316.

Abstract

Background Although the efficacy of percutaneous balloon mitral valvuloplasty in patients with unoperated mitral stenosis has been well documented, there exists less clear-cut data on its effectiveness in patients with mitral restenosis after previous surgical commissurotomy. Accordingly, the purpose of this study was to evaluate our immediate and midterm results of balloon mitral valvuloplasty in this subset of patients with previous mitral surgery.

Methods Between October 1991 and August 1995, 29 consecutive patients with mitral restenosis after prior surgical commissurotomy (group 1) underwent Inoue balloon mitral valvuloplasty. They were matched on a patient-to-patient basis with regards to baseline mitral echocardiographic score, mitral valve area, seventy of angiographic mitral regurgitation and follow-up duration with 29 other patients with unoperated mitral stenosis (group 2) who underwent balloon mitral valvuloplasty during the same study period.

Results Balloon mitral valvuloplasty yielded identical improvements in transmitral gradient and mitral valve area (from 0.8 to 1.6 cm2 determined echocardiographically, and similar changes in the severity of mitral regurgitation in both groups of patients. All procedures were successfully completed without major cardiac complications. Follow-up echocardiographic assessment in 73% of patients revealed equal mitral valve area (1.6 cm2) and a restenosis rate of 17%, with no difference in the restenosis rate between the two groups.

Conclusion Balloon mitral valvuloplasty in selected patients with mitral restenosis after past surgical commissurotomy can be performed safely and with similar immediate and midterm efficacy as in patients with de novo mitral stenosis.

Key Words: Balloon commissurotomy • mitral stenosis • mitral regurgitation • Inoue balloon


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