Results Of Percutaneous Mitral Valvotomy Research Articles

Percutaneous Mitral Valvotomy in Children and Adolescents: Immediate and Midterm Results

Objective: To analyze immediate and midterm results of percutaneous mitral valvotomy (PMV) in patients ≤ 18 year, a single centre experience of Sohag university hospital. Methods: Between May 2010 and May 2012, 64 procedures of Inoue technique mitral valvotomy were performed on 64 patients. The mean age was 15.8 ± 2.2 years; 75% were females. Results: Success was obtained in 96.8% of patients. Immediate complications were severe mitral regurgitation (3.1%), cardiac tamponade (1.6%) and embolic stroke in (1.6%). Late follow-up was obtained in 93.7% of the patients (at 6 and 24 months). Restenosis developed in 3 patients. Most of the patients had no symptoms at discharge but most of them had NYHA class I to II at 6 months to 2 years follow up. No patients died. Patients who operated early with MVA around 1.4 had best outcome. Conclusion: PMV represents a safe therapeutic option in young patients with mitral valve stenosis. In these patients, recurrence of symptoms and restenosis occurs at an earlier stage than in elderly. Earlier intervention carries better outcome and decreases restenosis rate.

Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study

Immediate and intermediate term results of percutaneous mitral valvotomy (PMV) are comparable to closed surgical commissurotomy (CSC). We aimed at exploring this relation in the long term. Previously, we randomized 40 consecutive patients with moderate to severe mitral stenosis [defined as mitral valve area (MVA) less than 1.5 cm²] to undergo either PMV (PMV group = 20 patients) or CSC (CSC group = 20 patients). For all patients, full echocardiographic assessment was performed before the procedure/operation. Patients assigned to PMV underwent the double balloon technique. Echocardiographic assessment was done following both procedures before discharge and repeated 1 and 6 months later. Echocardiographic follow-up was performed, thereafter, on a yearly basis for up to 15 years, with a mean follow-up period of 99 ± 12 months. Immediate echocardiographic results showed no statistically significant difference between the 2 groups regarding the final MVA or mean diastolic gradient across the mitral valve. Two patients dropped out from the CSC group and one from the PMV group. MVA was 1.8 ± 0.3 cm² versus 1.8 ± 0.4 cm² (p > 0.05) and mean diastolic pressure gradient across the mitral valve was 7 ± 4 mmHg versus 6.6 ± 4 mmHg (p > 0.05) in the PMV and CSC groups, respectively. Mitral restenosis occurred in 5 (26.3%) patients in the PMV group versus 5 (27.8%) patients in the CSC group (p > 0.05). Kaplan-Meier curves for restenosis-free survival showed no difference between the 2 groups. PMV achieves comparable results to CSC both in the short and long term.

Percutaneous transmitral commissurotomy in juvenile mitral stenosis—comparison of long term results of Inoue balloon technique and metallic commissurotomy

To compare the immediate and long term results of percutaneous mitral valvotomy using metallic commissurotome and Inoue balloon in juvenile mitral stenosis. Inoue balloon technique for mitral commissurotomy (IBMC) is well established and carried out worldwide in the treatment of juvenile mitral stenosis. Percutaneous mitral metallic commissurotomy (PMMC) is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. Thirty-three patients aged less than 20 years, who underwent PMMC, were compared with 33 age and sex matched control patients who underwent IBMC. Success of valvotomy, procedure related complications, and follow-up events of the two techniques were compared. Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups, 31/33. Complications like cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups. On follow-up of more than 3 years, both groups had comparable hemodynamic parameters and restenosis rates. Both IBMC and PMMC are successful in providing relief from severe juvenile mitral stenosis in terms of gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success and complication rates. The long term follow-up results are comparable at follow-up of more than 3 years.

Early (three-month) results of percutaneous mitral valvotomy with the Inoue balloon in 1,123 consecutive patients comparing various age groups

Since its initial description by Inoue et al in 1984,1 percutaneous mitral valvotomy (PMV) with the Inoue balloon has become a widespread nonsurgical technique to treat patients with symptomatic mitral valve stenosis. Results of large series of PMVs are available from regions with a high prevalence of rheumatic fever, where the procedure is performed predominantly in younger patients with little calcification of the mitral valve apparatus.2,3 From countries with a low prevalence of rheumatic fever, results from small series4 or multicenter observations5 are available. We report on the immediate and short-term results of 1,123 consecutive PMV procedures that were performed with the Inoue balloon between February 1989 and October 2000 in a single referral center and in a population with a very low prevalence of rheumatic fever.

Percutaneous mitral valvotomy in patients eighteen years old and younger. Immediate and late results.

OBJECTIVE - To analyze immediate and late results of percutaneous mitral valvotomy (PMV) in patients < or = 18 year. METHODS - Between August '87 and July '97, 48 procedures were performed on 40 patients. The mean age was 15.6 years; 68.7% were females four of whom were pregnant. RESULTS - Success was obtained in 91.7% of the procedures. Immediate complications were severe mitral regurgitation (6.3%) and cardiac tamponade (2.0%). Late follow-up was obtained in 88.8% of the patients (mean value=43.2+/-33.9 months). NYHA functional class (FC) I or II was observed in 96.2% of the patients and restenosis developed in five patients, at a mean follow-up of 29.7+/-11.9 months. Three patients presented with severe mitral insufficiency and underwent surgery. Two patients died. CONCLUSION - PMV represents a valid therapeutic option in young patients. In these patients, maybe because of subclinical rheumatic activity, restenosis may have a higher incidence and occur at an earlier stage than in others persons.

Update on Percutaneous Mechanical Mitral Commissurotomy

A reusable metallic valvotomy device has been developed with the goals of improving the results of percutaneous mitral valvotomy and increasing the cost‐effectiveness of the procedure. The device consists of a detachable and reusable metallic dilator with two articulated bars screwed at the distal end of a catheter. Using transseptal catheterization, the device is placed across the valve over a traction guidewire and then opened gradually by means of pliers up to a maximum of 40 mm. To date, the device was used in 168 patients with a broad spectrum of mitral valve disease. The procedure was successful in 95% of cases and resulted in an increase in mitral valve area from 1.01 ± 0.8 to 2.20 ± 0.7 cm2. No increase in mitral regurgitation was noted in 87% of cases. Bilateral splitting of the commissures was observed in 89%. Complications included the following: 2 severe mitral regurgitations (one requiring surgery), 1 pericardial tamponade, 1 transient cerebrovascular embolic event. The maximum number of consecutive patients treated with the same device was 35. The results obtained are at least comparable to those of current balloon techniques and confirm the possibility of safe multiple reuses of the device after sterilization.

Percutaneous mitral balloon valvotomy for patients with mitral stenosis

This study reports the immediate outcome, in-hospital complications, and long-term clinical follow-up of patients undergoing percutaneous mitral balloon valvotomy. In most series, this procedure is reported to increase mitral valve area from less than 1.0 cm2 to at least 2.0 cm2. The most important predictor of the immediate outcome of percutaneous mitral valvotomy is the echocardiographic score. The best results with percutaneous mitral valvotomy occur in those patients with echocardiographic scores of 8 or less. Mortality and morbidity with percutaneous mitral valvotomy are low and similar to surgical commissurotomy. There is less than 1% mortality, a 0% to 3.1% incidence of thromboembolic episodes and stroke, a 1% to 5.2% incidence of severe mitral regurgitation, a 0.2% to 4.1% incidence of pericardial tamponade, and a 3% to 16% incidence of left-to-right shunt. Survival (83 +/- 6% vs 48 +/- 8%), survival with freedom from mitral valve surgery (58 +/- 5% vs 25 +/- 5%), and event-free survival (51 +/- 6% vs 22 +/- 5%) at 80-month follow-up was greater in patients with echocardiographic scores of 8 or less compared with those with scores greater than 8 (P < 0.0001). Thus, the excellent immediate and long term results of percutaneous mitral valvotomy in patients with echocardiographic scores of 8 or less suggest that this procedure may be the treatment of choice in this group of patients.

Percutaneous mitral valvotomy using inoue and double balloon technique: Comparison of clinical and hemodynamic short term results in 350 cases

The results of percutaneous mitral valvotomy (PMV) by double balloon (N = 230, Group I) and Inoue single balloon (N = 120, Group II) technique were compared. The groups were similar with respect to baseline characteristics. Following PMV there were marked symptomatic and haemodynamic benefits in both the groups. There was significant increase in mitral valve area (MVA) estimated by Gorlin's equation (Group I: from 0.83 +/- 0.18 cm2 to 2.10 +/- 0.45 cm2, p < 0.001; Group II: from 0.83 +/- 0.17 cm2 to 2.16 +/- 0.39 cm2, p < 0.001) and by echoplanimetry (Group I: from 0.84 +/- 0.18 cm2 to 1.91 +/- 0.35 cm2, p < 0.001; Group II: from 0.88 +/- 0.17 cm2 to 1.96 +/- 0.30 cm2, p < 0.001). However, the percentage increase in MVA in the two groups by echoplanimetry (Group I: 136 +/- 59; Group II: 130 +/- 51; p = NS) and by Gorlin's equation (Group I: 164 +/- 69; Group II: 168 +/- 61; p = NS) were not statistically significant. Results were considered optimal when increase in MVA was > or = 1.5 cm2, percentage increase was > or = 50, and mitral regurgitation was < 2/4. Out of 216 patients in Group I where PMV could be performed, optimal results were achieved in 184 (85.2%) by Gorlin's equation and 178 (82.4%) by echoplanimetry. In Group II, out of 116 patients, optimal results were achieved in 107 (92.2%) by Gorlin's equation and 103 (89%) by echoplanimetry. Incidence of mitral regurgitation although higher in Group II (24.1% vs. 18.9%) was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of lnoue single-balloon versus double-balloon technique for percutaneous mitral valvotomy

The results of percutaneous mitral valvotomy by means of the lnoue single-balloon (N = 85, group 1) and the double-balloon (N = 322, group 2) techniques were compared in a nonrandomized study. The groups were not significantly different with regard to age, sex, calcification, or hemodynamic values before percutaneous mitral valvotomy. After percutaneous mitral valvotomy, patients in both groups had significant hemodynamic and clinical improvement. The increases in mitral valve area and cardiac output and the decreases in mitral valve gradient, mean pulmonary artery pressure, and mean left atrial pressure were greater in group 2. Mitral valve area determined by the Gorlin method increased 191% in group 2 and 106% in group 1; Doppler-determined mitral valve area increased 133% in group 2 and 98% in group 1. Optimal results were achieved in 93% of the patients in group 2 and 76% in group 1 ( p ≤ 0.0001). In group 1, 6% of patients had a left-to-right shunt as shown by angiography versus 14% in group 2 ( p ≤ 0.05). In group 2, 46% of patients had at least a 1 + increase in mitral regurgitation versus 52% in group 1. Among the patients who had an increase in mitral regurgitation, 36% of those in group 1 versus 9% in group 2 had a 2+ or more increase ( p ≤ 0.001). The mean balloon diameter to anulus ratio was larger in group 2, and the larger the balloon diameter to anulus ratio, the greater the increase in mitral valve area. Long-term follow-up will be needed to determine whether or not the immediate hemodynamic superiority of the double-balloon technique is clinically important.