Results of percutaneous balloon mitral valvotomy in young adults

Abstract

The results of percutaneous balloon mitral valvotomy (PBMV) were evaluated in 235 young patients (mean age 29 ± 11 years) with symptomatic rheumatic mitral stenosis, and the single-balloon Inoue technique was compared with the double-balloon Mansfield technique. PBMV was associated with a significant increase in Gorlin mitral valve area (0.78 ± 0.23 to 1.61 ± 0.64 cm 2; p < 0.001), and improvement in New York Heart Association functional class (2.78 ± 0.59 to 1.28 ± 0.58; p < 0.001). Mitral regurgitation increased significantly (0.4 ± 0.6 to 1.3 ± 1.0; p < 0.001), but was significant (≥3+) only in 19 patients (8%). Comparison of the Inoue and Mansfield techniques showed a significantly lower Gorlin mitral valve area after PBMV (1.55 ± 0.56 vs 1.74 ± 0.74 cm 2; p < 0.05), but a lower incidence of mitral regurgitation by color Doppler echocardiography (1.1 ± 0.7 vs 1.5 ± 0.8; p < 0.05) in the Inoue group. Patients were divided into those with nonpliable (valve score >8; group I) and pliable (score ≤ 8; group II) valves. Although significant increases in mitral valve area were obtained in both groups, mitral valve area by planimetry was significantly lower in group I (1.49 ± 0.46 vs 1.86 ± 0.44 cm 2; p < 0.05), whereas there was no difference in the amount of color Doppler mitral regurgitation (1.5 ± 1.0 vs 1.2 ± 0.7; p = NS). It is concluded that (1) in young patients with mitral stenosis, PBMV offers excellent palliation even in those with less ideally pliable valves; and (2) although the Inoue technique achieves smaller valve areas, it is accompanied by a lower incidence of mitral regurgitation.