Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy

Abstract

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 219 patients with symptomatic, severe rheumatic mitral stenosis. There were 59 men and 160 women, aged 19 to 76 years (mean 43). Pliable, noncalcified valves were present in 139 (group 1), and calcified valves or severe mitral subvalvular lesions, or both, in 80 patients (group 2). Atrial fibrillation was present in 133 patients (61%) and 1+ or 2+ mitral regurgitation in 59 (27%). Technical failure occurred with 3 patients in our early experience. There was no cardiac tamponade or emergency surgery. The only in-hospital death occurred 3 days after the procedure in a group 2 premoribund patient in whom last-resort PTMC created 3+ mitral regurgitation. Mitral regurgitation appeared or increased in 72 patients (33%); 3+ mitral regurgitation resulted in 12 patients (6%). There were 3 systemic embolisms. Atrial left-to-right shunts measured by oximetry developed in 33 patients (15%). Immediately after PTMC, there were significantly reduced (p = 0.0001) left atrial pressure (24.2 ± 5.6 to 15.1 ± 5.1 mm Hg), mean pulmonary artery pressure (39.7 ± 13.0 to 30.6 ± 10.9 mm Hg) and mitral valve gradient (13.0 ± 5.1 to 5.7 ± 2.6 mm Hg). Mitral valve area increased from 1.0 ± 0.3 to 2.0 ± 0.7 cm 2 (p = 0.0001) and cardiac output from 4.4 ± 1.4 to 4.7 ±1.2 liters/min (p < 0.01). The results mirrored clinical improvements in 209 patients (97%). Multivariate analysis showed an echo score >8, and valvular calcification and severe subvalvular lesions as independent predictors for suboptimal hemodynamic results. The cardiovascular event-free survival rate for group 1 was 100% up to 42 months; that for group 2 was 91% at 12 months, and held at 76% from 24 to 31 months. PTMC is safe, achieves good immediate and long-term results and is the procedure of choice in selected patients with mitral stenosis.