Farewell to surgical mitral commissurotomy for many patients.

Abstract

Percutaneous mitral balloon valvotomy (PMV) has been accepted as an alternative to surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. Previous studies have demonstrated that PMV produces good immediate and long-term follow-up results in a selected group of patients with mitral stenosis.1 2 3 4 Hemodynamic and clinical improvement is achieved in the majority of patients with rheumatic mitral stenosis. PMV resulted in a significant decrease in mitral gradient and an increase in mitral valve area with minimal morbidity and mortality. The majority of patients have a marked clinical improvement, and the hemodynamic and clinical improvement produced by PMV persist at long-term follow-up.2 3 4 On the other hand, surgical mitral commissurotomy has been used successfully for many years to treat patients with mitral stenosis. The results of closed or open surgical mitral commissurotomy have demonstrated favorable immediate and long-term hemodynamic and symptomatic improvement in selected patients with rheumatic mitral stenosis. Interpretation of long-term clinical follow-up of patients undergoing percutaneous mitral balloon valvuloplasty as well as their comparison with surgical commissurotomy series are confounded by heterogeneity in the patient population. Only few randomized studies have compared the results of PMV with those of surgical commissurotomy. In this issue of the journal, Farhat et al5 reported the results of a randomized trial designed to compare the immediate and long-term results of double-balloon PMV versus those of open and closed surgical mitral commissurotomy in a cohort of patients with severe rheumatic mitral stenosis. These patients were, from the clinical and morphological point of view, optimal candidates for both PMV and surgical commissurotomy (closed or open) procedures as demonstrated by a mean age of <30 years, absence of mitral valve calcification on fluoroscopy and two-dimensional echocardiography, and an echocardiographic score ≤8 in all patients. Their …