King Edward VII Memorial (KEM) Hospital, Bombay, India. Background Mitral restenosis often ..... In a study by Rutledge et a/."71 of 54 patients undergoing mitral ...
European Heart Journal (1996) 17, 1560-1564
Percutaneous balloon mitral valvotomy in mitral restenosis S. Gupta, A. Vora, Y. Lokhandwalla, P. Kerkar, S. Gupta, H. Kulkarni and B. Dalvi King Edward VII Memorial (KEM) Hospital, Bombay, India
Background Mitral restenosis often occurs within 5 to 15 years of surgical valvotomy. Percutaneous balloon mitral valvotomy is well established as a safe and effective alternative to mitral stenosis surgery, but only a few small studies have reported on the procedure.
Methods We analysed our experience of 614 consecutive patients undergoing balloon valvotomy and identified 84 patients (13-7%) with mitral restenosis following prior surgical valvotomy (Group I). The remaining 530 patients (863%) had not undergone previous surgery (Group II). The incidence of atrial fibrillation (19% vs 5-6%), mitral valve calcification (50% vs 306%) and total echo score >8 (54-8% vs 24-15%) was significantly higher in Group I. Both groups were comparable as regards their functional class, technique of valvotomy, mitral valve area (0-87 ± 0 1 8 vs 0-87 ± 015 cm2, P=ns), mean transmitral gradient (19-63 ± 6 0 1 vs 19-21 ± 5-67 mmHg, / J =ns), and mean pulmonary artery pressure (42-2 ± 190 vs 40-8 ± 14-4 mmHg, P=ns).
Introduction Rheumatic mitral stenosis continues to be a major problem in developing countries. Although surgical commissurotomy is an effective and time-tested treatment for patients with mitral stenosis, in 10-30% of patients undergoing surgical mitral commissurotomy a repeat procedure is necessary within 5-15 years'1'3'. In recent times, percutaneous balloon mitral valvotomy has Revision submitted 23 April 1996. and accepted 29 April 1996. Correspondence Dr Amit Vora. DM. Lecturer, Department of Cardiology, King Edward VII Memorial (KEM) Hospital, Parel, Bombay 12. India. 0195-668X/96/101560 + 05 S18 00/0
Conclusion We conclude that percutaneous balloon mitral valvotomy can be performed safely and effectively in patients with mitral restenosis following surgical valvotomy; the beneficial acute outcome is sustained, as shown at intermediate-term follow-up and is similar to that of patients undergoing balloon mitral valvotomy as an initial procedure. (Eur Heart J 1996; 17: 1560-1564) Key Words: Rheumatic heart disease, commissurotomy, pulmonary hypertension, intervention.
evolved as an effective alternative therapeutic modality for patients with mitral stenosis, with excellent shortand intermediate-term results.[4] However, there are limited data about the results of percutaneous balloon mitral valvotomy in patients with prior surgical commissurotomy15"71 and these studies are mostly from the West where the population with mitral restenosis is different from developing countries with respect to age, mitral valve pathology and occurrence of associated cardiac and non-cardiac abnormalities. The latent period between acute rheumatic fever and development of mitral stenosis is much shorter in the developing countries, thus re-stenosis is a very common problem in the second and early third decade of life'81. t* 1996 The European Society of Cardiology
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Aim (i)To evaluate the safety and efficacy of percutaneous balloon mitral valvotomy in patients with mitral restenosis. (ii) To evaluate the intermediate-term outcome of patients undergoing balloon mitral valvotomy after previous surgical valvotomy. (iii) To compare these patients with those undergoing balloon mitral valvotomy as the initial procedure.
Results After percutaneous balloon mitral valvotomy, the final mitral valve area (1-67 ±0-28 vs 169 ± 0-29 cm2, f=ns), mean transmitral-mitral gradient (612 ± 3 6 8 vs 502 ± 3-21 mmHg, />=ns) and mean pulmonary artery pressure (31-0 ± 15-2 vs 28-5 ± 111 mmHg, f=ns) were comparable. The success rate (93-0% vs 95-3%, P=ns) was similar in both groups. Significant mitral regurgitation was seen in four (4-8%) patients in Group I and 22 (4-1%) patients in Group II (/ > =ns). There were two deaths (2-4%) in Group I and five (0-9%) in Group II (/"=ns). The clinical and echo Doppler follow-up (8-40 months) studies showed that both groups were of similar NYHA class, and had similar mitral valve area (1 -65 ± 0-21 vs 1 -66 ± 0 3 cm2) and transmitral gradients (7-1 ± 3-8 vs 5 9 ± 3-5 mmHg).
Percutaneous balloon mitral valvuloplasty 1561
We retrospectively analysed and compared the acute and intermediate-term outcome in patients with mitral stenosis undergoing percutaneous balloon mitral valvotomy at our centre either as an initial procedure or following surgical valvotomy. The aims of the study were (1) to evaluate the safety and efficacy of percutaneous balloon mitral valvotomy, (2) to evaluate the intermediate-term outcome of patients undergoing percutaneous balloon mitral valvotomy after surgical valvotomy and (3) to compare these patients with those undergoing percutaneous balloon mitral valvotomy as an initial procedure.
Material and methods Patient selection
Definition of success Percutaneous balloon mitral valvotomy was regarded as successful if the mitral valve area post percutaneous balloon mitral valvotomy was > 1-5 cm2 or the gain was >50% of baseline with no significant mitral regurgitation15"71.
Statistical analysis All results are expressed as mean ± SD. Continuous variables were compared using the paired or unpaired t-test, whereas discrete variables were compared using chi-squared contingency tables. P
