BALLOON MITRAL COMMISSUROTOMY IN PATIENTS WITH PREVIOUS ANNULOPLASTY - OUR EXPERIENCE

Balloon mitral commissurotomy is an alternative to surgical commissuro tomy in the treatment of mitral stenosis and different studies have sh own its usefulness for restenosis following surgical commissurotomy. W e describe our experience in balloon mitral commissurotomy in five pat ients with previous commissurotomy and annuloplasty. Among 360 balloon commissurotomies performed in our hospital up to December 1993, 29 pr ocedures were performed on patients with restenosis after surgical com missurotomy, five of whom also had an annuloplasty (flexible ring in f our and rigid in one). The balloon commissurotomy was performed withou t complications using the Inoue single balloon technique. Mitral valve area increased from 0.9 +/- 0.1 cm(2) to 1.0 +/- 0.1 cm(2) by pressur e half-time, and from 1.0 +/- 0.2 cm(2) to 1.3 +/- 0.1 cm(2) by Gorlin formula. Two patients in functional class III underwent mitral valve replacement, 32 and 11 months later; the other three patients were in class II 38, 10 and 7 months later. The presence of a mitral ring shou ld not constitute a contraindication to balloon commissurotomy. Howeve r, the haemodynamic results are not favourable in our patients, probab ly due to the practical absence of commissural fusion and the ring's r estrictive effect on valvular stretching.