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European Heart Journal 2000 21(20):1683-1689; doi:10.1053/euhj.1999.1992
Copyright © 2000 by the European Society of Cardiology.
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Immediate and mid-term results of repeat percutaneous mitral commissurotomy for restenosis following earlier percutaneous mitral commissurotomy

B Iunga,f1, E Garbarza, P Michauda, O Fondarda, S Heloua, J Kamblockb, P Berdaha, P.-L Michela, P Lionetb, B Cormiera, G Papouinb and A Vahaniana

a Service de Cardiologie, Hopital Tenon, Paris, France
b Service de Cardiologie, Centre Hospitalier Territorial, Papeete, Tahiti, Polynésie Française

Received October 12, 1999; accepted October 13, 1999

Abstract

Aims This study assessed the results of repeat percutaneous mitral commissurotomy for mitral restenosis following a first procedure.

Methods and Results Repeat balloon commissurotomy was performed in 53 patients who had symptomatic restenosis a mean of 6±2 years (2–11) after a successful first procedure; seven patients had mildly calcified valves. All patients had restenosis with a fusion of both commissures as assessed by echocardiography. A double-balloon was used in one case and the Inoue technique in 52. Complications were stroke in one patient and severe mitral regurgitation (Sellers grade 3) in two. Valve area increased from 1·03±0·22 to 1·82±0·21cm2(P<0·0001) as assessed by planimetry. Good immediate results, defined as valve area ≥1·5cm2with no regurgitation >2/4, were obtained in 48 patients (91%). The 5-year survival rate without operation and in NYHA class I or II was 69±11% in the whole population, and 76±11% in the 48 patients who had had good immediate results.

Conclusion This study suggests that repeat balloon commissurotomy is a valid treatment for symptomatic restenosis after a first successful procedure. It gives good results in patients selected on the basis of favourable characteristics and the echocardiographic analysis of the mechanism of restenosis.

Key Words: Mitral valve, valvuloplasty, mitral restenosis

f1 Correspondence: Dr Bernard Iung, Service de Cardiologie, Hopital Bi Chat, 46 rue Henri Huchard, 75018 Paris, France.


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