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European Heart Journal 2003 24(14):1349-1356; doi:10.1016/S0195-668X(03)00257-4
Copyright © 2003 by the European Society of Cardiology.
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Balloon mitral commissurotomy in juvenile rheumatic mitral stenosis: a ten-year clinical and echocardiographic actuarial results

H Gamra*, F Betbout, K Ben Hamda, F Addad, F Maatouk, Z Dridi, S Hammami, M Abdellaoui, H Boughanmi, T Hendiri and M Ben Farhat

Cardiology Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia

* Corresponding author. Habib Gamra, MD, Cardiology Department, Fattouma Bourguiba University Hospital-5000 Monastir, Tunisia. Tel.: +216-734-471-08; Fax: +216-734-606-78
E-mail address: hgamra{at}rns.tn

Received 31 January 2003; revised 3 April 2003; accepted 18 April 2003

Aims To evaluate the safety, efficacy and long-term actuarial results of balloon mitral commissurotomy in young patients with severe rheumatic mitral stenosis.

Methods and results Event-free survival and freedom from restenosis were analyzed in 110 patients 20 years old or younger (group 1) and compared with those of 554 adults (group 2). Young patients were less frequently in atrial fibrillation (6% vs 35%, P<0.001) and had less mitral valve deformities (echo score 5.9±2.1 vs 7.5±3.0, P<0.0001). Mitral valve area index by 2D-echo was of 0.66±0.1cm2/m2in group 1 and 0.67±0.1cm2/m2in group 2 (P=ns) and was larger in group 1 (1.5 vs 1.3cm2/m2) after the procedure (P<0.0001). There were more complications in group 2 (8.4% vs 0%, P=0.01). Procedural success was obtained in 110 (100%) patients of group 1 vs 501 (92%) patients of group 2 (P<0.0001). At follow-up mitral valve area index was 1.34cm2/m2in group 1 and 1.16cm2/m2in group 2 (P<0.0001). At 10 years, freedom from restenosis was 61% in group 1 vs 71% in group 2 (P=0.35) and event-free survival was 74% and 69% respectively (P=0.15).

Conclusion Balloon mitral commissurotomy is safe and effective in young with rheumatic mitral stenosis and provides better immediate results than in adults. However long-term outcome was similar between the 2 groups: 2/3 of patients were alive and free from clinical events at 10 years.

Key Words: Balloon mitralcommissurotomy • Young • Follow-up • Restenosis


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