Postoperative Outcomes of Mitral Valve Repair for Mitral Restenosis after Percutaneous Balloon Mitral Valvotomy

BACKGROUND: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. METHODS: In this study, we assessed 15 patients (mean age, 47.7+/-9.7 years; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5+/-7 years. The mean preoperative Wilkins score was 9.4+/-2.6. RESULTS: The mean mitral valve area obtained using planimetry increased from 1.16+/-0.16 cm2 to 1.62+/-0.34 cm2 (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from 202.4+/-58.6 ms to 152+/-50.2 ms (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4+/-4.0 mmHg to 5.8+/-1.5 mmHg (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39+/-16 months). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467-64.866). CONCLUSION: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.

Medico-Surgical Cooperative Treatment of Pulmonary Atresia with Intact Ventricular Septum

PURPOSE: The actual clinical examples of co-appliance of catheter intervention with surgical procedures in the treatment of pulmonary atresia with an intact ventricular septum(PA/IVS) which we have experienced in our institution are here shown, and the anatomical and hemodynamical profiles between each method is compared. METHODS: Medical records of 33 patients with PA/IVS who underwent various treatment from January, 1995 to December, 2000 were reviewed for a retrograde study. RESULTS: In three out of 10 patients who underwent percutaneous balloon pulmonary valvotomy (PPV), residual pulmonary stenosis were observed in their out patient department(OPD) follow-ups, eventually necessitatig balloon pulmonary valvuloplasty(BPV). One out of three patients exhibited deterioration of tricuspid regurgitation after BPV, requiring surgical tricuspid annuloplasty(TAP). Two out of the seven patients who received primarily surgical right ventricle outlet tract(RVOT) repair without any systemic-pulmonary shunt or intervention needed additional intervention employing cardiac catheterization after operation. Two patients received interventional catheterization before surgical RVOT repair. In five out of 11 cases of Fontan type operation, coil embolization of collateral circulation was done before total cavo-pulmonary connection(TCPC), and in three cases, interventional catheterization was needed after TCPC. CONCLUSION: Both medical and surgical treatment modalities are widely used in management of PA/IVS patients, and recent results prove that medico-surgical cooperative treatment is essential.

Percutaneous Mitral Balloon Valvotomy in Patients with Restenosis after Surgical Commissurotomy: A Comparative Study

BACKGROUND: Because its efficacy and percutaneous approach, percutaneous mitral ballon valvotomy(PMV) could be an alternative to surgery for mitral restenosis after surgical commissurotomy, somewhat decreasing the mortality and morbidity associated with second thoracotomy. This study assesses the efficacy of PMV in patients with mitral restenosis after surgical commissurotomy compared with in patients without prior surgery. METHODS: PMV were performed in 367 patients to compare the effectiveness between patients with mitral restenosis after surgical commissurotomy(group 1, n=22) and patients with unoperated mitral stenosis(group 2, n=345). Twenty two had undergone closed or open mitral commissurotomy average 11.2 years before. RESULTS: There were no significant differences in clinical profiles between two groups. Mitral valve area was increased from 1.0+/-0.8 to 1.8+/-0.6cm2 in group 1 and 0.9+/-0.3 to 2.0+/-0.7cm2 in group 2(p>0.05). Mitral gradient was decreased from 14+/-5.9 to 6+/-2.6mmHg in group1 and 18+/-7.0 to 7+/-5.3mmHg in group2(p>0.05). Increment of mitral regurgitation and significant left to right shunt after PMV were not significantly different(10% versus 14.7%, 5% versus 10.4% respectively, p>0.05). Optimal results defined as final valve area more than 1.5cm2 with gain a more than 25% of initial valve area were attained in 75% of patients in group1 and in 84.3% of group 2 patients(p>0.05). CONCLUSIONS: PMV in mitral restenosis after surgical commissurotomy may be safe in selected patients and equally effective as in unoperated mitral stenosis.

Intervençäo cirúrgica em pacientes submetidos a procedimento para valvoplastia mitral por cateter-baläo / Surgery in patients undergoing to a catheter balloon mitral valvoplasty procedure

Objetivo: Estudar as características d e pacientes submetidos a valvoplastia mitral por cateter-balão (VMPB) que necessitaram de intervenção cirúrgica após a mesma. Casuística e Métodos: 105 pacientes submetidos a VMPB divididos em grupo I (Gl) composto por 18 pacientes operados e Grupo II (GII) por 87 não submetidos à intervenção cirúrgica no coração. Foram analisados: 1 ) idades; 2) sexo; 3) área valvar mitral (AVM) e gradiente transvalvar mitral médio (G) ao ecodopplercardiograma; 4) caráter da VMPB; 5) método utilizado na VMPB; 6) intervalo de tempo entre VMPB e cirurgia relacionado à indicação operatória; 7) achado operatório; 8) operação efetuada; 9) evolução pós-operatória...

Purpose: To study the characteristics of patients undergoing catheter-balloon mitral valvoplasty (CBVM) procedure who needed surgical intervention after CBMV. Patients and Methods: One hundred and five patients submitted a CBMV were divided in to Group I (GI) of eighteen surgical patients and Group II (GII) of eighty-seven non-surgical patients. The following parameters were analyzed. 1) age; 2) sex; 3) mitral valve area (MVA) and mean transvalvar gradiente (G) by echodopplercardography (2D); 4) Character of CBMV; 6) Relation of time between CBMV and Surgery with surgical indication; 7) Surgical fidings; 8) Surgical procedure and 9) Post-operative evolution...