COMPLICATIONS OF PERCUTANEOUS MITRAL COMM ISSUROTOMY - PERSONAL-EXPERIENCE AND A REVIEW OF THE LITERATURE

Percutaneous mitral commissurotomy was performed in 484 patients by th e double balloon technique and by Inoue's technique in 33 patients. Th e average age of the patients was 33.6 +/- 13 years (range : 8 to 72 y ears); 30 % were in atrial fibrillation. A primary failure was observe d in 10 patients (2 %). The acute mortality was 0.4 % and first month mortality 0.6 %, the main cause being perforation of the left ventricl e. The incidence of systemic embolism was 2 %, related to atrial fibri llation (p < 0.016) : this complication disappeared after systematic u tilisation of transcesophageal echocardiography. Grade 4+ mitral regur gitation was created in 5 patients (1 %) and grade 3+ in 20 others (3. 9 %). A score > 8 (p < 0.006) and preexisting grade 1+ mitral regurgit ation (p < 0.005) were predictive factors of these severe regurgitatio ns. They were also more frequent with Inoue's technique (10.5 %; p < 0 .05). Surgical intervention was necessary during the first month in 5 patients and at long-term (38 +/- 24 months) in 15 others. A tear in t he anterior leaflet and ruptured chordae tendinae were the main mechan isms. The most common minor complication was the creation of a small i nteratrial shunt (16 %) without any immediate or long-term complicatio ns. With a major complication rate of 4.2 %, the mitral surface area i ncreased from 0.97 to 2.2 cm(2) and the cardiac index from 3 to 3.6 l/ min/m(2) : left atrial pressure fell from 27 to 15 mmHg (p < 0.0001) : the incidence of residual stenosis was only 2 %. Seventy nine per cen t of patients were asymptomatic and 16 % were paucisymptomatic (class II) at long-term. Systematic transoesophageal echocardiography to dete ct thrombi, the use of pig-tail or Inoue catherters, effective heparin isation during a prolonged procedure and improved experience of the me dical teams, should result in a further reduction of the risks of perc utaneous mitral commissurotomy.