Results of percutaneous mitral commissurotomy in 200 patients

To assess the feasibility and efficacy of percutaneous mitral commissurotomy (PMC), the procedure was attempted in 200 patients with severe mitral stenosis. There were 154 women and 46 men, their mean age was 43 ± 16 years (range 13 to 79) and 15 were older than 70 years of age. Fortyfour had had previous surgical commissurotomy. Forty were in New York Heart Association class II, 152 in class III and 8 in class IV. In regard to valvular anatomy, 67 had calcified valves, 58 had pliable valves and only mild subvalvular disease, and 75 had flexible valves but extensive subvalvular disease. Grade 1+ mitral regurgitation was present in 62 and grade 2+ in 2. In 11 patients the procedure was discontinued because of complications in 3 and technical failure in 8. Six of the 8 technical failures occurred during the first 15 attempts. Effective PMC was performed in 189 patients using 1 balloon in 23 and 2 balloons in 166. After PMC, there was a significant improvement in mean left atrial pressure (21 ± 7 to 12 ± 5 mm Hg, p <0.0001), mean mitral gradient (16 ± 6 to 6 ± 2 mm Hg, p <0.0001), cardiac index (2.6 ± 0.8 to 3.1 ± 0.8 liters/min/m², p <0.001) and valve area assessed by hemodynamics (1.1 ± 0.3 to 2.2 ± 0.5 cm², p <0.0001) and 2-dimensional echocardiography (1 ± 0.3 to 1.9 ± 0.4 cm², p <0.0001). No patient died. Embolism occurred in 8 (4%), with no further sequelae. Sixteen (8%) had atrial septal defect detected by oxymetry. After PMC, severe mitral regurgitation was noted in 8 patients (4%) with calcified valves or extensive subvalvular disease. Multivariate analysis identified valve anatomy and balloon size to be independent predictive factors of the final result. One hundred patients from the first 105 were followed >6 months (mean 9 ± 3). Nine subsequently underwent operations and 85 from the remainder improved to New York Heart Association class I or II. Valve area, as assessed by 2-dimensional echocardiography, remained stable in all but 4 (who lost >50% of the initial gain). In conclusion, PMC is a safe and effective treatment in a wide range of patients with mitral stenosis.