Indications, complications, and short-term clinical outcome of percutaneous transvenous mitral commissurotomy.

Abstract

Percutaneous transvenous mitral commissurotomy was performed in 106 consecutive patients. Significant symptomatic improvement was achieved in 97 patients (92%). Mean left atrial pressure decreased (from 18 +/- 8 to 11 +/- 8 mm Hg, p less than 0.00001), mean mitral diastolic pressure gradient decreased (from 12 +/- 7 to 7 +/- 6 mm Hg, p less than 0.00001), and mitral valve area increased (from 1.40 +/- 0.40 to 2.00 +/- 0.50 cm2, p less than 0.00001). Based on echocardiographic characteristics of the mitral apparatus, patients were grouped retrospectively in three categories: pliable (group 1, n = 37), semipliable (group 2, n = 59), and rigid (group 3, n = 10). Clinical success was achieved in 36 patients of group 1 (97%) and in 55 patients of group 2 (93%). Only six patients in group 3 (60%) improved symptomatically (p less than 0.001 vs. group 1, p less than 0.001 vs. group 2). The severity of mitral regurgitation increased in five patients of group 1 (14%), in 12 of group 2 (20%), and in three of group 3 (33%). Six patients had recurrent symptoms at 9 months after commissurotomy. Recurrence of symptoms was significantly more frequent in group 3 compared with the other two groups (group 1, 3%; group 2, 4%; and group 3, 50%; p less than 0.0001 vs. groups 1 and 2). Multiple regression analysis identified the previously mentioned echocardiographic characteristics of the mitral apparatus as the significant predictor for clinical outcome. Thus, percutaneous transvenous mitral commissurotomy can be considered a safe and effective treatment for patients with pliable valves. Patients with semipliable or with rigid valves should be selected for operation very carefully.

Acute and long-term follow-up results of percutaneous mitral balloon valvuloplasty: a single-center study

“…Percutaneous mitral balloon valvuloplasty (PMBV) has been developed as an alternative modality to surgical closed commissurotomy for mitral stenosis (MS) (1), and excellent hemodynamic improvement with favorable outcome has been reported by many investigators (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Although numerous studies have documented favorable immediate and intermediate-term results, long-term echocardiographic follow-up studies are rare (1)(2)(3)(4)(5)(6)(10)(11)(12)(13).…”

Percutaneous Balloon Mitral Valvuloplasty

“…18 In clinical practice, young patients (Ͻ50 years old) with favorable valve anatomy have usually showed particularly good immediate results. [32][33][34] …”

“…Most of the adverse complications relevant to this procedure occur during the procedure 32 (ie, during the process of interatrial septum puncture, manipulation of the Inoue balloon catheter in the left atrium, and commissurotomy of the mitral valve by Inoue balloon catheter). Major complications with regard to the Brockenbrough puncture are related to penetration of the Brockenbrough needle into the adjacent structure (ie, ascending aorta and the postatrium pericardial space).…”

Percutaneous Transluminal Mitral Commisuriotomy for Mitral Stenosis in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

“…PTMC clinical applications have been widely accepted and a large series has been reported. 7 It was proven that, it is as effective as open valvotomy and more effective than closed valvotomy. 8,9,10 As there are very few contraindications for the procedure, so it has greatly decreased the need for surgery.…”