Thirty-five patients with severe mitral stenosis underwent percutaneous mitral valvotomy (PMV). There were 29 female and six male patients (mean age 49 3 years, range 13 to 87). After transseptal left heart catheterization, PMV was performed with either a single-(20 patients) or double-(14 patients) balloon dilating catheter. Hemodynamic and left ventriculographic findings were evaluated before and after PMV. There was one death. Mitral regurgitation developed or increased in severity in 15 patients (43%). One patient developed complete heart block requiring a permanent pacemaker. PMV resulted in a significant decrease in mitral gradient from 18 + 1 to 7 + 1 mm Hg (p < .0001) and a significant increase in both cardiac output from 3.9 0.2 to 4.6 + 0.2 liters/min (p < .001) and in mitral valve area from 0.8 + 0.1 to 1.7 0.2 cm2 (p < .0001) Effective balloon dilating diameter per square meter of body surface area correlated significantly with the decrease in mitral gradient but did not correlate with the degree of mitral regurgitation. There was no correlation of age, prior mitral commissurotomy or mitral calcification with hemodynamic results. PMV is an effective nonsurgical procedure for patients with mitral stenosis, including those with pliable valves, those with previous commissurotomy, and even those with Circulation 75, No. 4, 0-0, 1987. ALTHOUGH the prevalence of rheumatic mitral stenosis has markedly decreased in the United States,l rheumatic heart disease is still common in underdeveloped and developing countries, accounting for 25% to 40% of all cardiovascular diseases.2'3 Surgical mitral commissurotomy is a low-risk surgical technique that results in symptomatic and hemodynamic improvement in selected patients. Percutaneous mitral valvotomy (PMV) or valvotomy via femoral cutdown using a balloon dilating catheter has recently been used in a small number of patients`as an alternative to surgical mitral commissurotomy. This study reports the results to PMV in 35 patients with severe mitral stenosis. Materials and methodsPatients. The patient population included 35 patients who presented with severe, symptomatic mitral stenosis. There were

The PS(3) System has been safely translated from the preclinical setting to first-in-human implantation. Both patients studied experienced a reduction in MR after device implantation, with significant SLS shortening. Further clinical trials will be needed to assess long-term efficacy and durability.

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Percutaneous mitral valvuloplasty is a promising new technique for the treatment of mitral stenosis, with a relatively low complication rate reported to date. To assess the sequelae of this procedure, Doppler echocardiographic studies were prospectively performed before and after percutaneous mitral valvuloplasty in a series of 172 patients (mean age 53 +/- 17 years). After balloon dilation, mitral valve area increased from 0.9 +/- 0.3 to 2 +/- 0.8 cm2 (p less than 0.0001), mean gradient decreased from 16 +/- 6 to 6 +/- 3 mm Hg (p less than 0.0001) and mean left atrial pressure decreased from 24 +/- 7 to 14 +/- 6 mm Hg (p less than 0.0001). Although most patients were symptomatically improved, six (4%) were identified who had unusual sequelae evident on Doppler echocardiographic examination immediately after percutaneous mitral valvuloplasty. These included rupture of a posterior mitral valve leaflet, producing a flail distal leaflet portion with severe mitral regurgitation detected on Doppler color flow mapping (n = 1); asymptomatic rupture of the chordae tendineae attached to the anterior mitral valve leaflet with systolic anterior motion of the ruptured chordae into the left ventricular outflow tract (n = 1); a double-orifice mitral valve (n = 1); and evidence of a tear in the anterior mitral valve leaflet (n = 3), producing on both pulsed Doppler ultrasound and color flow mapping a second discrete jet of mitral regurgitation in addition to regurgitation through the main mitral valve orifice. All six patients made a satisfactory recovery and none has required mitral valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)