0359: Percutaneous balloon mitral commissurotomy in children and young adults with rheumatic mitral stenosis

Abstract

To determine the efficacy and the safety of percutaneous balloonmitral commissurotomy (PBMC) in young patients (aged under 18 years – olds) with rheumatic mitral stenosis and to compare these results with those of adult patients. Percutaneous transvenous mitral commissurotomy (PTMC) using the Inoue technique was performed in 480 patients with rheumatic mitral stenosisbetween 1998 and 2013. 41 were aged under 18 years – old (group 1). The other 439 patients (group 2) had a mean age of 34±11.9 years. All patients were assessed clinically. An echocardiography was performed before and after the procedure. Mean age in group 1 was 15±2.95 years (range 8 to 18) with a women predominance (73.2% vs. 26.8%.). In group 1, there was a significant increase of the mean mitral valve area index (MVAI) (0.84±0.24 vs 1.78±0.39cm 2 , p <0.001), a significant reduction of the mean transmitral pressure gradient (21.78±6.62to8.75±5.87 mm Hg, p <0.001) and of the mean left atrial pressure (28.46±7.59to12.87±5.57 mmHg, p < 0,001) from pre- to post-PBMC, respectively. Mild mitral regurgitation developed in 12 and moderate mitral regurgitation developed in 3 patients.The mean follow-up was 92±40 months. Improvement in symptomatic status by at least one NYHA class was seen in the majority of patients.A good result during the follow up was observed in 46.3% of controlled patients and restenosis in 53.7% of cases with an average of 46±34 months. The immediate hemodynamic results in children were compared to 439 adult patients who underwent PBMC in the same period. The outcome was similar in both groups. Children were found to have significantly higher rate of mitral restenosis compared to adults (53.7% vs. 31.9%). Despite a high rate of restenosis, PBMC is very effective and safe in children, and consider that it should be the procedure of choice for young patients with symptomatic rheumatic mitral stenosis.