Percutaneous mitral commissurotomy for restenosis after surgical commissurotomy

Abstract

Percutaneous mitral commissurotomy is safe and provides good immediate results in selected patients with restenosis after surgical commissurotomy. After good immediate results, the conditions of more than half of the patients remained improved at 8 years, enabling reoperation to be deferred.

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.…”

“…The long term results are less favorable in Europe and the United States 12,25 , where the patients are older and the mitral valve anatomies are more altered. 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.…”

“…In literature the independent factors for events are: reduced mitral valve area after the procedure 8,13,19,22,25,40 , atrial fibrillation before the procedure 8,10,11,13,29,30 , prior mitral commissurotomy surgery 12,13,25,26,32 (even though the restenosis group after valve repair surgery or balloon valvoplasty can present satisfactory results and evolution 34,41 ), presence of severe mitral valve regurgitation after the procedure 8,12,13,19,21,26,32,40 , elevated functional class before the procedure 8,10,12 , elevated echocardiographic score before the procedure 11,12,18,19,22 , advanced age [8][9][10][11][12] , unfavorable mitral valve anatomy [8][9][10][11]24 , elevated mean pulmonary pressure after the procedure 9,…”

Valvotomia mitral percutânea: experiência inicial com o novo balão único de dilatação "tipo Inoue"

“…A realização de nova intervenção, geralmente, é indispensável, pelo retorno de sintomas. Em pacientes tratados cirurgicamente e com baixo escore ecocardiográfico, a valvotomia mitral percutânea com único balão pode ser realizada com segurança [22][23][24][25][26][27] . Estudos prévios demonstram a eficácia e a segurança desse procedimento, que se torna atrativo por evitar nova intervenção não-cirúrgica.…”

Percutaneous Approaches to Valvular Disease

“…Conversely, valve replacement should be performed in patients with severe calcification, particularly if the other characteristics are also unfavorable. Such a strategy, starting with PMC and performing surgery secondarily in case of need, can also be proposed when the risk of surgery is high: in the elderly, 32 in whom PMC can be considered as a palliative treatment; in patients with a previous history of surgical commissurotomy 33 or aortic valve replacement; and during pregnancy if symptoms persist despite medical therapy. 34 The complication rate of the procedure is clearly related to the experience of the team.…”