Akut- und Langzeiterfolg der perkutanen Mitralklappenvalvuloplastie

Abstract

Since its introduction in the eighties by Inoue, percutaneous balloon valvotomy has been established as treatment of choice for symptomatic degenerative mitral stenosis. Especially young patients with rheumatic fusion of the mitral commissures and no calcification of the still pliable valve leaflets are candidates for this procedure. In these patients balloon valvotomy is expected to give results comparable or even superior to operative commissurotomy. This report presents the short and long-term results of 33 patients (24 females, 9 males; median age: 53 years) that underwent percutaneous mitral valvotomy (PMV) at the cardiac unit of the university hospital in Cologne during the last three years. The intervention was immediately successful in 31 patients (94%). The median mitral valve area was increased after PMV to 2.0 +/- 0.5 cm(2) an increase of mean opening area of 82% and a decrease of mean pressure gradient by about 50%. Follow-up date at 12 and 24 months were available for 21 and 12 patients, respectively. During the first 12 months after intervention four patients subsequently had to have surgical mitral valve replacement, one of them together with a coronary artery bypass graft. One patient, who had undergone PMV in cardiogenic shock died after the intervention. A 12-month follow-up demonstrated a mean mitral valve area of 1.7 +/- 0.4 cm(2) as assessed by echocardiography. After 24 months comparable mean valve area was 1.7 +/- 0.4 cm(2). One other patient required operative valve replacement, but there were no further deaths. The data collected from this very heterogeneous group of patients at the cardiac unit of the university hospital in Cologne confirms the observation that PMV is beneficial in young patients with favorable valve morphology and shows that it is indicated not only as a palliative measure but also as treatment option in older patients with more complex alterations of the mitral valve.