Immediate and Late Outcomes after Percutaneous Mitral Co,mmissurotomy

Abstract

Background:Percutaneous mitral commissurotomy(PMC) has been known as an effective therapeutic modality for moderate to severe mitral stenosis. However, long-term results and factors influencing late outcome after PMC remain to be elucidated. Materials and Methods:Three hundred and forty-six patients received PMC at Seoul National University Hospital between August, 1988 and March, 1996. We evaluated long-term results of these patients and assessed demographic, clinical, echocardiographic and hemodynamic variables in order to identify predictors of immediate and late outcomes. Results:PMC was completed without major complication or technical failure in 339(98%) out of 346 cases. A good immediate result was obtained in 67% of cases. Multivariate study identified echocardiographic score(P=0.004) and left atrial volume(P=0.009) as independent predictors of immediate outcome. The estimated 3-year and 5-year event-free survival rates were 95.8±2.5% and 90.6±4.3%, respectively. According to multivariate analysis, the independent predictors of late outcome were pre-PMC left atrial volume(P=0.03), post-PMC mitral valve area(P=0.01), and severity of mitral regurgitation after PMC(P=0.03). Conclusion:Percutaneous mitral commissurotomy as a treatment for patients with mitral stenosis is safe, and achieves good long-term results. Pre-procedural echocardiographic score, left atrial volume, post-procedural mitral valve area, and severity of mitral regurgitation affect the immediate and late outcomes after PMC.