PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY USING AN INOUE BALLOONIN CHILDREN WITH RHEUMATIC MITRAL-STENOSIS

Percutaneous transvenous mitral commissurotomy(PTMC) using the Inoue t echnique was performed in 557 patients with rheumatic mitral stenosis. Of these, 107 were children aged 10-18 years (mean+/-SD 14.5+/-2.3). All patients were symptomatic New York Heart Association (NYHA) Class II(n = 78) and Class III (n = 29). All were in sinus rhythm. Following PTMC, the mitral valve area (MVA increased from 0.73+/-0.18 to 1.7+/- 0.53 cm(2) (P<0.001). There was a significant fall in mean transmitral gradient from 15.6+/-5.2 to 5.1+/-2.3 mmHg, and in mean pulmonary art ery pressure from 41+/-15 to 28.4+/-10 (P<0.001). Cardiac tamponade de veloped in one patient. One patient developed severe mitral regurgitat ion requiring emergency mitral valve replacement. Five patients (4.7%) developed moderate mitral regurgitation. There was no mortality or ce rebral embolism in any of the children. Four patients (3.7%) had oxime try evidence of atrial septal defect. Mean mitral valve area and trans mitral gradient at 14 months mean follow up was 1.68+/-0.4 cm(2) and 6 +/-3.5 mmHg, respectively, and were comparable to the immediate post-P TMC results. Two patients (1.8%) developed restenosis. The immediate h aemodynamic results in children were compared to 450 adult patients wh o underwent PTMC in the same period. The outcome was similar in both g roups. Children were found to have significantly higher pulmonary arte ry pressure compared to adults. We found that PTMC using an Inoue ball oon is very effective and safe in children, and consider that it shoul d be the procedure of choice for young patients with symptomatic rheum atic mitral stenosis. (C) 1997 Elsevier Science Ireland Ltd.