Efficacy of balloon valvuloplasty using multi-track technique for 50 cases with tight mitral stenosis at national heart institute and follow up one year

ABSTRACT

Mitral balloon valvuloplasty is the treatment of choice for severe mitral stenosis in young patients with a minimally calcified and pliable mitral valve. The Multi-Track system, devised by Bonhoeffer et al. in 1995, simplifies the Double Balloon technique. With this system, one of the balloons is a rapid exchange balloon, while the other has a conventional design, enabling both to be aligned in the mitral valve orifice over a single guide wire. The main advantage of such technique is lower cost, not only regarding the balloon, but also because they can be reused after resterilization with ethylene oxide. [Links et al., 2000] The study was designed to assess the efficacy of balloon valvuloplasty using multi-track technique for 50 cases of tight mitral stenosis [MVA Heart Institute and follow up for one year regarding the efficacy of dilatation and improvement of functional class. Randomized study using 50 cases with tight mitral stenosis +/- mitral regurge mild or less, with mean age 30 +/- 10 years, 33 females and 17 males, with mean score 7.8 +/- 1.2 were subjected to transthoracic, transoeophageal and multitrack double balloon technique for mitral valvuloplasty with post-valvuloplasty transthoracic echocardiography. The balloon was successful in almost all cases with decrease of maximum pressure gradient from 25 +/- 8.2 mmHg to 13 +/- 5.4 mmHg. The mean pressure gradient decreased from 14 +/- 5.9 mmHg to 6 +/- 2.7 mmHg. The mitral valve area increased by Planimetry from 1.0 +/- 0.2 cm[2] to 1.8 +/- 0.3 cm[2], and by Doppler from 1.0 +/- 0.2 cm[2] to 1.78 +/- 0.4 cm[2]. No mortality was detected and no major complications. The MVA was mitral valve surgery [4%]. Follow up of around 50 cases after one year showed no one-year mortalility. The mean pressure gradient by Doppler, the mitral valve area by planimetry and by Doppler were around previous figures. No major complications were found. The MVA remained the same or improved and were around Achievement of functional class 1-2 was present in almost all cases and restenosis rate was nearly nil [0%]. Multi-Track double balloon technique is reasonable for mitral valvuloplasty with good results. Selection of patients is highly recommended. The valve area was > 1.8 cm[2] in 82% of cases which is statistically significant and physician experience