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

ABSTRACT

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.