Evolução muito tardia da valvotomia percutânea por balão na estenose mitral grave

Abstract

Background: Percutaneous balloon mitral valvotomy is safe and effective in patients with severe symptomatic mitral stenosis with immediate and long-term results comparable to those of surgical intervention. This study was aimed at reporting the very late follow-up results of the first percutaneous balloon mitral valvotomies performed at our institution and at identifying predictive factors of restenosis. Methods: From 1987 to 1991, 200 consecutive patients were submitted to percutaneous balloon mitral valvotomy. Clinical and echocardiographic evaluations were performed prior to the procedure, 48 hours after the procedure and annually thereafter. results: Mean age was 32 ± 12 years; 86.5% were female and 80.5% were in New York Heart Association functional class III or IV. Mean Wilkins score was 7.6 ± 1.2 and procedure success was observed in 87.5% (175/200) of the patients. During follow-up, 129 patients (74%) were followed up for 140 ± 79 months. Restenosis was observed after the first procedure in 46.5% (60/129) patients and a second percutaneous balloon mitral valvotomy was performed in 25 patients, a third one in 4 patients and a fourth one in 1 patient. The probability of being restenosis-free was 85% at 5 years, 60% at 10 years and 36% at 20 years. Left atrial diameter (P = 0.034), and preoperative (P = 0.013) and postoperative (P = 0.038) transvalvar gradient were predictors of restenosis. conclusions: In a very late clinical follow-up, percutaneous balloon mitral valvotomy provided long-lasting results in over one-third of the patients and showed that repeated procedures may be performed safely in selected patients. The

Valvoplastia mitral percutânea por balão: sobrevivendo ao teste do tempo

“…Percutaneous balloon mitral valvuloplasty has definitely survived the test of time. Aguiar Fillho et al 7 once more confirmed the success of this groundbreaking structural percutaneous intervention as a first-line treatment for rheumatic mitral stenosis. The historical and well-established success of percutaneous mitral balloon valvuloplasty should inspire the new generation of structural heart disease interventionists to further innovate and change the landscape of valvular heart disease treatment once and for all.…”

“…Patient selection is essential for predicting the immediate outcome and follow-up results of percutaneous mitral balloon valvuloplasty. Aguiar Filho et al, 7 in this edition of the Revista Brasileira de Cardiologia Invasiva, highlight this fundamental issue of patient selection, as the mean Wilkins score of the current population was 7.6 and only 32 patients (16%) had a score > 8. This is no surprise, given the known expertise and experience of this group of clinical investigators, with distinct surgeons such as Esteves and Abizaid, who have been involved in developing and perfecting percutaneous valve therapy since the early days.…”