Comparison between Percutaneous Balloon Valvuloplasty and Open Commissurotomy for Mitral Stenosis

Abstract

Eighty patients with tight and pliable mitral stenosis were randomized in a prospective trial comparing percutaneous balloon valvuloplasty and open commissurotomy. Mitral valve area increased significantly in both groups immediately after the procedures. However, a decrease in mitral valve area occurred in both groups at 6, 12 and 24 months during the follow-up. There was no death in either group. Two patients had significant mitral regurgitation after percutaneous balloon valvuloplasty. After 24 months, all patients in the commissurotomy group and 97.4% of the patients in the balloon valvuloplasty group were in New York Heart Association functional class I or II.

Comparação da evolução a longo prazo da valvoplastia mitral percutânea por balão com a técnica de inoue versus a do balão único: análise dos fatores de risco para óbito e eventos maiores

“…Survival in this study at the end of evolution was 95.7% in the single balloon group and 97.9% in the Inoue balloon group. Major event free survival was 82.3% in the single balloon group and 91.7% in the Inoue balloon group in comparison to the findings in literature between 16% and 90% during followup of four to twelve years [6][7][8][9][10][11][12]19,25,38,39 due to differences in the patient groups.…”

“…Mortality in literature ranges from zero 37 to 18% 12,[18][19][20]26,38 during followup of one to ten years and is greater in groups with higher echocardiographic scores 12,13 , reaching as high as 17% to 18% 9,18 depending on unfavorable characteristics or longer follow-up. The follow-up period for the single balloon group (54 ± 31 months) was greater than that of the Inoue balloon group (34 ± 26 months).…”

“…In the multivariate analysis, echocardiographic scores > 8 and age > 50 years were the only independent predictors of death during long term evolution. In literature, older patients, higher echocardiography scores, higher functional classes before and after the procedure, elevated systolic pulmonary pressure and left ventricle end diastolic pressure and severe mitral regurgitation during the balloon valvoplasty procedure have been cited as independent variables to predict death 12,13,38 .…”

No More Comparative Studies of Percutaneous Balloon Valvuloplasty versus Open Surgical Commissurotomy for Mitral Stenosis

“…Dear Sir, I read with interest yet another comparative study between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis [1]. I hope this will be the last such comparative study, because it simply confirmed five previous studies [2][3][4][5][6], all of which showed comparable results between these two methods of treatment for mitral stenosis.…”

Valvular heart disease in women

“…Percutaneous BMV is a good option for young women with MS, because it can lead to a substantial increase in valve area with sustained benefi t for many years [ 43 ]. Because clinical trials have found BMV to be equivalent or superior to closed surgical commissurotomy, the latter procedure largely has been abandoned [44][45][46]. Suitability for BMV is determined by valve morphology and the amount of mitral regurgitation (MR).…”