Balloon mitral commissurotomy for mitral restenosis after surgical commissurotomy

Abstract

Balloon mitral commissurotomy (BMC) was performed in 113 patients. Of these patients, 27 (24%) (25 women and 2 men, aged 49 ± 13 years) had recurrent mitral stenosis 13 ± 6 years (range 5 to 29) after surgical Commissurotomy. Eleven patients (41%) were considered at high risk for surgery. BMC resulted in an increase in mitral valve area from 1.1 ± 0.3 to 1.9 ± 0.7 cm 2 (p < 0.0001), and a decrease in mean mitral gradient from 16 ± 7 to 6 ± 3 mm Hg (p < 0.0001). An optimal result of BMC (increase in valve area ≥25% with a post-BMC valve area ≥1.5 cm 2) was obtained in 18 patients (67%). The results did not differ from those observed in the 86 patients of our entire series without prior surgical Commissurotomy. Patients with an optimal result of BMC had a more recent surgical Commissurotomy and lesser morphologic alterations of the mitral valve than did those with a nonoptimal result. Patients with echocardiographic scores <10 had an 80% success rate of BMC; however, this rate decreased to 29% for those with scores ≥10. One patient (4%) died from a cerebrovascular accident. Clinical follow-up at 1 year showed persistent clinical improvement in 89% of patients with an optimal result of BMC; 72% were in New York Heart Association class I and 17% in class II. Thus, BMC is a safe and effective short- and long-term procedure for patients with mitral restenosis after surgical commissurotomy; because of its percutaneous approach, avoiding the risks associated with a second thoracotomy, BMC can be considered the treatment of choice in these patients.