Efficacy of Mitral Balloon Valvuloplasty for Mitral Restenosis After Surgical Commissurotomy

In patients with mitral restenosis who had undergone a previous surgical commissurotomy, balloon valvuloplasty was thought to be little effective. The purpose of this study was to compare the immediate and long-term outcome of patients undergoing percutaneous mitral balloon valvuloplasty (MBV) with and without a previous closed mitral commissurotomy (CMC). Inoue balloon technique was used in all interventions. Fifteen patients with a previous CMC (CMC+) and 18 patients without CMC (CMC-) who underwent MBV were included in the study. 17.1±6.9 years passed between CMC and MBV. Atrial fibrillation was more common (66.7% versus 16.7%, p=0.005) and echocardiographic Wilkins score was higher (8.0±1.1 versus 6.7±1.1, p<0.001) in the CMC+ group. There were no differences (p>0.05) between mitral valve areas (MVA) and pulmonary artery peak systolic pressures (PAPSP) of the two groups. In the first post-PMBV day echocardiographic measurements, MVA rose from 1.12±0.18 cm2 to 1.73±0.15 cm2 (p<0.05) in the CMC+ group and from 1.05±0.15 cm2 to 1.88±0.28 cm2 in the CMC- group (p<0.05). Mean mitral gradient (MMG) fell from 10.8±3.2 mmHg to 4.4±1.6 mmHg (p=0.001) and PAPSP from 45.8±12.3 mmHg to 34.4±9.6 mmHg (p<0.05) in the CMC+ group and from 12.7±4.6 mmHg to 4.5±2.2 mmHg (p<0.001) and from 58.2±21.2 mmHg to 36.5±8.7mmHg (p<0.05) in the CMC- group. In the first annual control of patients, MVA was 1.58±0.13 cm2, PAPSP was 38.4±9.2 mmHg and MMG was 6.5±3.1 mmHg in the CMC+ group and 1.63±0.2 cm2, 39.1±10.6 mmHg and 6.1±1.9 mmHg, consecutively in the CMC- group. We believe, MBV after CMC seems to be an affective alternatif treatment. (Türk Kardiyol Dern Arş 2004; 32: 203-207)