RESULTS OF PERCUTANEOUS DOUBLE-BALLOON MITRAL COMMISSUROTOMY IN ONE MEDICAL-CENTER IN TUNISIA

Percutaneous balloon mitral commissurotomy was attempted in Tunisia, w here rheumatic fever is still endemic, in 463 consecutive patients wit h severe rheumatic mitral valve stenosis. Their mean age +/- SD was 33 +/- 12 years (range 8 to 68), 324 patients (70%) were women, and 327 (71%) were in sinus rhythm. Valvotomy was technically successful in 45 4 patients (98%). The mean mitral valve gradient decreased from 20 +/- 7 to 6 +/- 4 mm Hg, mean left atrial pressure decreased from 27 +/- 8 to 15 +/- 6 mm Hg, cardiac index increased from 3.0 +/- 0.7 to 3.6 +/ - 0.8 L/min/m(2), and Gorlin mitral valve area, from 0.97 +/- 0.19 to 2.2 +/- 0.4 cm(2) (all p <0.001). Two-dimensional echocardiographic mi tral valve area increased from 1.03 +/- 0.18 to 2.15 +/- 0.36 cm(2) (p <0.00001). A final valve area of greater than or equal to 1.5 cm(2) w as achieved in 98% of patients. Multivariate analysis identified a pre -mitral valve area <0.8 cm(2) and an echocardiographic score (echo sco re) greater than or equal to 12 as the strongest predictors of residua l stenosis (final mitral valve area <1.5 cm(2)). Major procedural comp lications included mortality (0.4%), tamponade (0.7%), thromboembolism (2.0%), severe mitral regurgitation (4.6%), significant (pulmonary to systemic flow ratio greater than or equal to 1.5) interatrial shunt ( 4.8%). Four hundred thirty patients were followed vp between 6 and 82 months (mean 37 +/- 22): 95% were in functional class I to II without reintervention, and 7 patients died (1.6%); restenosis (echocardiograp hic mitral valve area <1.5 cm(2)) occurred in 10.4% of patients. The 3 -year Kaplan-Meier freedom from restenosis was 92%, and from reinterve ntion 93%. Because fluoroscopic calcium and postprocedure mitral valve area less than or equal to 1.8 cm(2) were the independent predictors of restenosis, patients with calcified valves should be selected for t his procedure on a case-to-case basis.