Valvotomia percutânea com balão em pacientes com menos de 18 anos / Percutaneous balloon valvotomy in patients under 18 years

INTRODUÇÃO: Valvotomia mitral percutânea (VMP) é o tratamento de escolha em pacientes com estenose mitral reumática. Em pacientes jovens, o implante de uma prótese pode trazer diversas complicações no curto e longo prazo como durabilidade bastante reduzida. O OBJETIVO desse trabalho é descrever os resultados imediatos e acompanhar o follow-up desse grupo de pacientes. MÉTODOS: Foram selecionados, em uma coorte retrospectiva, pacientes que se submeteram a VMP com idade menor do que 18 anos devido a estenose mitral reumática. Os procedimentos e a ecocardiografia foram realizados em centro único. RESULTADOS: 58 pacientes (15,41±2,42 anos, 69% mulheres) foram submetidos a 66 procedimentos. A área valvar prévia foi de 0,87±1,94 cm2 e após o procedimento passou a ser 2,00±0,46cm2, com 74% de insuficiência mitral graduada como menor do que discreta, 98,5% tinham ritmo sinusal e o procedimento foi considerado sucesso em 89,4%, sucesso parcial em 6,1% e insucesso 4,5%. No acompanhamento de curto prazo, 19,7% evoluíram para necessidade de cirurgia, sendo 3% emergencial. 22 casos evoluíram para necessidade de redilatação, sendo 12 casos ainda com menos de 18 anos e os demais acima dessa idade. CONCLUSÃO: A VMP é o método de escolha para o tratamento da estenose mitral reumática em pacientes abaixo de 18 anos, de mostrando segurança e bons resultados. Nessa faixa etária a prevalência em homens foram significativamente superior.

Use of covered stents in the management of coarctation of the aorta.

We report our experience with the use of covered stents for the management of coarctation of the aorta. From December 2001 to March 2004, nine patients (seven males; median age, 31 years; mean weight, 65 +/- 15 kg) underwent implantation. Indications included critical or atretic native coarctation (n = 4), patients >50 years of age (n = 2), associated patent ductus arteriosus (n = 1) or adjacent aneurysm (n = 1), and the presence of a circumferential fracture within a previously implanted stent (n = 1). The covered balloon-expandable Cheatham-Platinum stent and the self-expandable stent graft Braile were employed. Adequate implantation was observed in all patients. Gradients were reduced from 54 +/- 14 to 3 +/- 8 mmHg and the coarctation site increased from 2.4 +/- 2.9 to 15.9 +/- 4.3 mm. The patent ductus arteriosus was immediately closed and the aneurysm excluded. Two patients >35 years with aneurysmal ascending aorta and metallic aortic prosthesis had aneurysm formation at follow-up, with one undergoing aneurysm exclusion using a Braile stent. Although covered stents are useful in the management of selected patients with coarctation, aneurysm formation may still occur in patients with markers of aortic wall weakness. Refinements in the deployment technique and/or the stent design are needed to eliminate this risk.

New percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum.

We report new percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum, in 3 newborns who had this birth defect. There was mild to moderate hypoplastic right ventricle, a patent infundibulum, and no coronary-cavitary communications. We succeeded in all cases, and no complications related to the procedure occurred. The new coaxial radiofrequency system was easy to handle, which simplified the procedure. Two patients required an additional source of pulmonary flow (Blalock-Taussig shunt) in the first week after catheterization. All patients had a satisfactory short-term clinical evolution and will undergo recatheterization within 1 year to define the next therapeutic strategy. We conclude that this technique may be safely and efficiently performed, especially when the new coaxial radiofrequency system is used, and it may become the initial treatment of choice in select neonates with pulmonary atresia and intact ventricular septum.

Percutaneous closure of ductus arteriosus with the amplatzer prosthesis. The Brazilian experience.

OBJECTIVE - To report the results of percutaneous occlusion of persistent ductus arteriosus with the Amplatzer prosthesis in 2 Brazilian cardiological centers. METHODS - From May 1998 to July 2000, 33 patients with clinical and laboratory diagnosis of persistent ductus arteriosus underwent attempts at percutaneous implantation of the Amplatzer prosthesis. The median age was 36 months (from 6 months to 38 years), and the median weight was 14kg (from 6 to 92kg). Sixteen patients (48.5%) were under 2 years of age at the time of the procedure. All patients were followed up with periodical clinical and echocardiographic evaluations to assess the presence and degree of residual shunt and possible complications, such as pseudocoarctation of the aorta and left pulmonary artery stenosis. RESULTS - The minimum diameter of the arterial ducts ranged from 2.5 to 7.0mm (mean of 4.0+/-1.0, median of 3.9). The rate of success for implantation of the prosthesis was 100%. Femoral pulse was lost in 1 patient. The echocardiogram revealed total closure prior to hospital discharge in 30 patients, and in the follow-up visit 3 months later in the 3 remaining patients. The mean follow-up duration was 6.4+/-3.4 months. All patients were clinically well, asymptomatic, and did not need medication. No patient had narrowing of the left pulmonary artery or of the aorta. No early or late embolic events occurred, nor did infectious endarteritis. A new hospital admission was not required for any patient. CONCLUSION - The Amplatzer prosthesis for persistent ductus arteriosus is safe and highly effective for occlusion of ductus arteriosus of varied diameters, including large ones in small symptomatic infants.

Indications, technique, results and clinical impact of reocclusion procedures for residual shunts after transcatheter closure of the patent ductus arteriosus.

PURPOSE: To assess the results of reocclusion procedures for late residual shunts after transcatheter closure of the patent ductus arteriosus. MATERIAL AND METHODS: Nineteen patients underwent reocclusion procedures either with Rashkind technique (2 patients) or with coils. Mean age was 96.5 months and mean interval between the initial and the additional procedure was 15.7 months. In 5 patients, the duct was balloon-dilated prior to occlusion. RESULTS: In 3 patients the procedure was unsuccessful because it was impossible to cross the duct using either a guide wire or a catheter. Immediate or late complete occlusion occurred in 13 patients. Two patients required a third procedure for complete closure. One patient developed severe intravascular hemolysis after coil implantation and was sent to surgery. The rate of final late residual shunting decreased from 17.1% to 6.6% (5/76) in the umbrella group and from 15.8% to 1.8% (1/56) in the coil group. CONCLUSIONS: Reocclusion procedures are indicated after one year of persistent shunting following the primary procedure. They are generally effective and reduce significantly the rate of late residual shunting. In patients with tiny shunts, the duct may need to be dilated. Coils are preferred because of their low cost.

Transcatheter embolization of congenital coronary arterial fistulas in adults.

In this report, we describe our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. From November 1992 to November 1996, 5 symptomatic patients, aged from 47 to 70 years, underwent transcatheter occlusion of fistulas using a retrograde arterial approach. All had chest pain or dyspnea on exertion. Detachable balloons were used in 4 patients, and Gianturco coils in 1. Detachable balloons were implanted through a Debrun system, while the coils were implanted through a 5 French right coronary Judkins catheter. Both were passed through an 8 French guiding catheter (Amplatz II). Each patient had a single fistula. The fistulas originated from the right coronary artery in 3 patients, and from the circumflex artery in 2. They drained into the pulmonary trunk in 3 patients, into the right atrium in 1, and into a bronchial artery in the other. All fistulas were occluded completely in the catheterization laboratory, and the procedures were uncomplicated. At follow up, 3 patients underwent coronary angiography, and there was no evidence of recanalization. Transcatheter embolization in adults of single congenital coronary fistulas with detachable balloons and coils is safe and effective and can be regarded as an acceptable alternative to surgery.

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.

[Current role of therapeutic heart catheterization in pediatric cardiology] / O papel atual do cateterismo terapêutico em cardiologia pediátrica.

OBJECTIVE: Cardiac catheterization has begun to be employed for therapeutic purposes since the middle sixties. In this paper the authors review the current indications, technique and results related to each of the interventional procedures. It also includes a brief sample of the Instituto Dante Pazzanese experience for illustrative purpose. METHODS: The main procedures that are addressed include balloon and blade atrial septostomy (Rashkind and Park procedures), pulmonary valvuloplasty, aortic valvuloplasty, mitral valvuloplasty (for rheumatic mitral stenosis), angioplasty for coarctation of aorta with or without stent implantation, angioplasty for pulmonary artery stenosis with or without stent implantation, percutaneous occlusion of the patent ductus arteriosus, percutaneous occlusion of atrial septal defects and balloon dilation of stenosed Blalock-Taussig shunts. The authors make a review of the most important papers published in the literature about Interventional Pediatric Cardiology, including their own experience. RESULTS: Good or excelent therapeutic results are achieved for pulmonic stenosis, coarctation of aorta, patent ductus arteriosus, atrial septal defects and pulmonary branch stenosis. Satisfactory palliations are obtained for aortic stenosis, rheumatic mitral stenosis and complex congenital heart diseases that require balloon atrial septostomy. CONCLUSIONS: Due to the recent technological development, pediatric therapeutic heart catheterization makes it possible to treat or palliate about 30% of all congenital or acquired heart diseases with encouraging results, sparing some patients from the need of cardiac surgery.

[Initial experience in percutaneous closure of interatrial communication with the amplatzer device]. / Experiência inicial no fechamento percutâneo da comunicação interatrial com a prótese de Amplatzer.

PURPOSE: To evaluate our initial experience with percutaneous closure of secundum type atrial septal defects (ASD) with the Amplatzer septal occluder. METHODS: Seven patients underwent occlusion by anterograde approach, under general anesthesia and transesophageal echocardiography (TEE) guidance. One child had 2 ASD and a patent ductus arteriosus (PDA). The ASD size ranged from 8.7 to 20 mm as measured by TEE. A transthoracic echocardiogram was performed in the morning after the procedure. RESULTS: Eight devices were successfully implanted in 7 patients and the PDA was occluded with a Gianturco coil at the same session. In this patient, there was an episode of supraventricular tachycardia during the occlusion of one ASD which was reverted with adenosin. All patients were discharged the day after, with complete occlusion of all defects. CONCLUSION: The procedure is safe, effective and versatile. It can be applied as an initial alternative to the treatment of selected patients with ASD.

[Overall experience with percutaneous occlusion of patent ductus arteriosus]. / Experiência global no fechamento percutâneo do canal arterial.

PURPOSE: To evaluate the overall experience of our institution with percutaneous occlusion of the patent ductus arteriosus. METHODS: Since December/92, 150 patients underwent 178 procedures (85-Rashkind technique; 87-Gianturco coils; 6-Duct Occlud). Median age was 6.5 years (1 to 57). Mean minimum ductal diameter was 3.05 +/- 1.24 mm (1 to 8). Clinical and echocardiographic evaluations were performed periodically. RESULTS: Adequate implantation was achieved in 143 (95.3%) patients. Prevalence of immediate residual shunting was 52.1%, falling to 15.9% during follow-up. This figure decreased to 5.2% after new additional procedures. Umbrella and coil embolization occurred in 1 and 12 procedures, respectively. Hemolysis and mild stenosis of left pulmonary artery were observed in one patient each. There was no mortality. CONCLUSION: This therapeutic modality is safe and efficacious with good follow-up results.

[Results of percutaneous balloon valvuloplasty in membranous subaortic stenosis]. / Resultados da valvoplastia percutânea por cateter balão na estenose subaórtica em membrana.

PURPOSE: To evaluate the results of percutaneous balloon valvuloplasty (PBV) for membranous subaortic stenosis (MSAS). METHODS: Seven patients with MSAS were submitted to PBV using the retrograde approach. Hemodynamic and angiographic studies were performed before and after the procedure. The balloon/annulus ratio varied between 0.9 to 1.05. RESULTS: The systolic gradient (SG) between the left ventricle (LV) and aorta was reduced from 57.8 +/- 11.6 to 22.0 +/- 8.6 mmHg (p < 0.001) and the LV systolic pressure from 154.5 +/- 30.3 to 118.7 +/- 18.4 mmHg (p < 0.001). One patient had arterial occlusion and was submitted to surgical embolectomy and another one showed severe mitral regurgitation combined with aortic insufficiency (AI) and required surgical valvuloplasty. There was no mortality. Four patients had a 11 +/- 10 month follow up: the SG measured by echocardiogram was 34 +/- 7 mmHg and no patient showed worsening of the AI. CONCLUSION: PBV is an effective procedure to reduce the subaortic SG, with an acceptable morbidity and persistence of the results in the short term follow up. PBV is a valid alternative as an initial mode of therapy in the management of patients with MSAS.

[Simultaneous treatment of pulmonary valve stenosis and patent ductus arterious by interventional catheterization]. / Tratamento simultâneo da estenose pulmonar valvar e da persistência do canal arterial através do cateterismo intervencionista.

The association of pulmonary valve stenosis and patent ductus arteriosus is uncommonly found in clinical practice of pediatric cardiology. The authors describe 2 patients with this association that were successfully treated in the same procedure by interventional cardiology: first case, a 14 month old boy was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 71 to 3 mmHg. The 2.0 mm of diameter and conical shape duct was successfully occluded using a 38-5-5 coil; second case, a 20 month old girl was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 60 to 5 mmHg. An attempt to close the 3.5 mm of diameter and concial shape duct using coil was performed, but the device embolized into the pulmonary artery. After immediate retrieval, a 12 mm Rashkind umbrella was implanted. Indication of treatment of both conditions, technical aspects and complications related to the procedures, and patients follow up are also discussed.

Tratamento simultâneo da estenose pulmonar valvar e da persistência do canal arterial através do cateterismo intervencionista / Simultaneous Treatment of Pulmonary Valve Stenosis and Patent Ductus Arteriosus by Interventional Cardiology

A associaçäo entre estenose pulmonar valvar e persistência do canal arterial näo é freqüente na prática clínica da cardiologia pediátrica. Säo descritos dois casos de portadores dessa associaçäo, tratados simultaneamente, em um mesmo procedimento, através do cateterismo intervencionista: 1§ caso, criança de 14 meses submetida a valvoplastia pulmonar percutânea com queda no gradiente sistólico entre a artéria pulmonar e o ventrículo direito de 71 para 3mmHg. O canal arterial, de 2,0mm de diâmetro e do tipo cônico foi ocluído com um coil 38-5-5; 2§ caso, criança de 20 meses submetida a valvoplastia pulmonar percutânea com queda no gradiente sistólico entre a artéria pulmonar e o ventrículo direito de 60 para 5mmHg. Tentativa de oclusäo do canal, de 3,5mm de diâmetro e do tipo cônico, utilizando-se coil foi realizada sem sucesso devido a embolizaçäo para a artéria pulmonar. O dispositivo foi imediatamente resgatado e uma umbrella de 12mm foi implantada com sucesso. Discute-se a indicaçäo de tratamento das condiçöes, aspectos técnicos e complicaçöes relativas ao procedimento e seguimento dos pacientes.

The association of pulmonary valve stenosis and patent ductus arteriosus is uncommonly found in clinical practice of pediatric cardiology. The authors describe 2 patients with this association that were successfully treated in the same procedure by interventional cardiology: first case, a 14 month old boy was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 71 to 3 mmHg. The 2.0 mm of diameter and conical shape duct was successfully occluded using a 38- 5-5 coil; second case, a 20 month old girl was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 60 to 5 mmHg. An attempt to close the 3.5 mm of diameter and conical shape duct using coil was performed, but the device embolized into the pulmonary artery. After immediate retrieval, a 12 mm Rashkind umbrella was implanted. Indication of treatment of both conditions, technical aspects and complications related to the procedures, and patients follow up are also discussed

Resultados da valvoplastia percutânea por cateter baläo na estenose subaórtica em membrana / Results of percutaneous balloon valvuloplasty for membranous subaortic stenosis

OBJETIVO - Avaliar os resultados da valvoplastia percutânea por cateter baläo (VPCB) na estenose sub-aórtica em membrana (ESAM). MÉTODOS - Sete pacientes com diagnóstico de ESAM foram submetidos a VPCB por via retrógada. Estudos hemdinâmicos e angiográficos foram realizados antes e após o procedimento. A relaçäo baläo/anel variou de 0,9 a 1,05. RESULTADOS - O gradiente sistólico (GS) entre o ventrículo esquerdo (VE) e a aorta foi reduzido de 57,8ñ 11,6 para 22,0ñ8,6mmHg (p<0,001) e a pressäo sistólicaem VE de 154,5ñ30,3 para 118,7ñ18,4mmHG(p<0,001). Um paciente paresentou oclusäo arterial necessitando de embolectomia cirúrgica e um outro apresentou insuficiência mitral severa aliada a insuficiência aórtica (IAo), requerendo plastia cirúrgica. Näo tivemos mortalidade. Quatro pacientes tiveram seguimento de 11ñ10 meses: o GS pelo ecocardiograma foi de 34ñ7mmHG e näo houve progressäo de o. CONCLUSÄO: A VPCB é um procedimento eficaz na reduçäo imediata de gradiente subaórtico, com morbidade aceitável e com manutençäo dos resultados a curto prazo. Consideramos como uma alternativa válida na abordagem inicial dos pacientes com ESAM.

[The percutaneous closure of patent ductus arteriosus with the Rashkind technic. The initial experience of the Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil]. / Cierre percutáneo del conducto arterioso con la técnica de Rashkind. Experiencia inicial del Instituto Dante Pazzanese de Cardiología-São Paulo-Brasil.

The authors report their experience with the percutaneous closure of the patent ductus arteriosus with the Rashkind technique. They performed 42 procedures with a success of 97.6% and one embolization episode. The mean age was 8.7 +/- 6.7 years, the mean weight was 25.0 +/- 15.8 Kg and the minimum diameter of the ductus was 4.0 +/- 1.3 mm. The immediate overall prevalence of residual shunt was 48.8% falling to 21% in a mean follow-up of 17 +/- 13 months in 29 cases. Two patients underwent late reocclusion: one with a new umbrella and the other with a coil. Another patient had an immediate severe residual shunt and it was reoccluded in the same procedure with a coil. The anatomical type and minimum internal diameter of the ductus, age and weight, size of the umbrella and the rotation of the umbrella were not predictors of residual shunt. There were no deaths, hemolysis, endarteritis or fracture of the umbrella's arms. One patient remained with a slight gradient in the left pulmonary artery. The authors conclude that the Rashkind technique is safe and efficient and has good long term results. It should be considered as the first line therapeutic modality in the treatment of selected patients with persistent ductus arteriosus.

[Pulmonary atresia with intact ventricular septum. Valvar perforation by radiofrequency]. / Atresia pulmonar com septo ventricular íntegro. Perfuração valvar por radiofreqüência.

Six days old neonate with pulmonary atresia and intact ventricular septum is reported in which a communication was established between the right ventricle and the pulmonary artery. The membraneous atresia was perforated with a special radiofrequency catheter 2F connected to a Hat 200S radiofrequency generator (Osypka). The energy necessary to perforation was 15W. After perforation of the atresia, balloon dilation was performed (balloon diameter: 2, 3, 4mm of coronary angioplasty and 5, 8mm Penta Medi-tech). The valve was completely opened giving the continuity between right ventricle and pulmonary artery.

[Mitral double catheter-balloon valvuloplasty, hemodynamics evaluation of 52 cases one year after the procedure]. / Valvoplastia mitral com duplo cateter-balão, avaliação hemodinâmica de 52 casos um ano depois do procedimento.

PURPOSE: To evaluate the late hemodynamic and angiographic results of 52 patients who underwent mitral valvoplasty by the double balloon technique in the treatment of the rheumatic mitral stenosis. METHODS: The mean follow-up was of 18 months and the patients had a Doppler-echocardiogram and cardiac catheterization one year after dilatation. Of the 52 patients 84.6% were female and the mean age was 21.9% years. Eighty one percent were in NYHA class I whereas 5.7% had atrial fibrillation at the end of 18 months. RESULTS: Immediately after valvoplasty 46 patients (88.5%) had a valvar area larger, and 6 (11.5%) smaller than 1.5 cm2. The first group had a good clinical outcome with maintenance of the clinical, echocardiographic and angiographic results in the late follow-up, including the diastolic gradient and the valvar area. Of the 6 cases with mitral area smaller than 1.5 cm2, 2 had a good clinical evolution, 2 were re-dilated, 1 was scheduled for surgery and the last one is under clinical management but with poor hemodynamic results. Three (5.7%) cases developed an atrial septal defect after the procedure, with hemodynamic repercussion in 1. Mitral regurgitation developed in 16 cases (+ in 8, +/++ in 8) without changes during the follow-up period. CONCLUSION: Double balloon mitral valvoplasty is a safe effective method in the treatment of the rheumatic mitral stenosis, and offers a better evolution in patients with a valvar area larger than 1.5 cm2 after the dilatation.

[Outpatient heart catheterization. An analysis of experience accumulated over 10 months]. / Cateterismo cardíaco ambulatorial. Análise da experiência acumulada em 10 meses.

PURPOSE: To identify patients suitable for outpatient cardiac catheterization strategy, based on social aspects, risks and complications, for a 24 hour period. METHODS: In a series of 2.126 cases submitted to cardiac catheterization at the Instituto Dante Pazzanese de Cardiologia, between September 1990 and June 1991, were excluded: a) those over 75 years of age; b) the acute ischemic syndromes; c) those in NYHA functional class IV; d) patients who used 7 or 8 French femoral angiographic catheters; e) patients who had undergone general anesthesia, electrophysiological study or endomyocardial biopsy. After the procedure, the patients were observed for a 3 hour period and in the absence of any complication, they were discharged from the hospital, returning the next day for clinical evaluation. If any complication occurred it was registered. RESULTS: In a cohort of 719 eligible patients, 68% were male, with a mean age of 55.3 years. Sixty one per cent were in NYHA functional class I and most of them (80.8%) were studied by the brachial approach. Eighty-three per cent of the patients were submitted to coronary angiography, with 52% of them having coronary artery disease. Four hundred and fourteen patients were not discharged on the same day: 217 did not have their procedures finish after 6 p.m., 111 for social-economical reasons, 23 because of their physician's refuse, 8 because of left main coronary disease, 55 because of any kind of complication. All the 305 patients who were discharged on the same day, did not have shown any complication in the next day evaluation. CONCLUSION: Outpatient cardiac catheterization is a safe technique in selected patients, making possible the accomplishment of a greater number of procedures improving bed utilization and decreasing hospital costs.

[Mitral valvuloplasty with double balloon catheter. Analysis of 200 cases]. / Valvoplastia mitral com duplo cateter-balão. Análise de 200 casos.

PURPOSE: To study the immediate clinical, echocardiographic and hemodynamic results of 200 patients who underwent percutaneous mitral balloon valvotomy (PMV) with double balloon technique. METHODS: Two hundred patients were submitted to PVM for treatment of congestive heart failure secondary to severe mitral stenosis, between August 1987 to July 1991. Their mean age was 35.2 years, and 86.5% were female patients: 81% of them was in functional class, New York Heart Association (NYHA) III or IV; 4% was in atrial fibrilation and 4% had previous surgical commissurotomy. RESULTS: PMV was successfully performed in 89% of the patients. The mitral valve area, by pressure half time method, increased from 0.91 +/- 0.27 to 2.10 +/- 0.47 cm2, p < 0.001; the mean mitral gradient decreased from 20.86 +/- 6.16 to 4.26 +/- 3.13 mmHg, p < 0.001; the left atrium and mean pulmonary artery pressure decreased from 22.3 +/- 7.1 to 11.9 +/- 8.3 and 36.47 +/- 12.93 to 24.56 +/- 9.98 mmHg, p < 0.001, respectively. Complications related to transeptal technique occurred in 12 patients, which resulted in cardiac tamponade in 5 and death in 1. In 19 patients the punction of the atrial septum could not be performed. Mitral regurgitation (MR) immediately after PMV appeared 1+ or more grade in 50 patients, increased in 8 patients and remained unchanged in 11 patients. Ten patients needed mitral valve replacement in the first 48h after PMV, for treatment of severe MR. CONCLUSIONS: PMV produces excellent immediate results and can be considered an alternative to surgery for the relief of mitral stenosis.