IMMEDIATE AND LONG-TERM RESULTS OF BALLOON MITRAL COMMISSUROTOMY FOR RHEUMATIC MITRAL-STENOSIS - COMPARISON BETWEEN INOUE AND DOUBLE-BALLOON TECHNIQUES

We examined the immediate results and 2-year follow-up of percutaneous transvenous mitral commissurotomy (PTMC) using the Inoue balloon (IB) and double-balloon (DB) techniques. Short-term comparisons have been described, but long-term comparisons have not been available. PTMC was performed in 208 adult patients with symptomatic mitral stenosis (MS) and mitral valve area (MVA) of 0.94 +/- 0.2 cm(2), by use of the IB i n 157 (73.4%) and the DB technique in 56 (26.3%). Procedures were perf ormed successfully and without complications in 198 (93%) cases. Adequ ate mitral dilatation (MVA greater than or equal to 1.6 cm(2)) without significant regurgitation was obtained in 179 (86%) of 192 patients. The final MVA was 2.0 +/- 0.43 cm(2) after IB and 2.06 +/- 0.51 cm(2) after DB (not significant). Technical difficulties and complications w ere more frequent with DB (16% vs 3.8%; p < 0.001). Severe mitral regu rgitation (grade III to IV) occurred in 4.6% of IB and 4.1% of DB (not significant), whereas grade I mitral regurgitation was greater with I B (21% vs 10.2%; p = 0.01). A total of 172 patients were monitored an average of 23.8 +/- 10.6 months, with 83% in New York Heart Associatio n functional class I, echocardiographic MVA of 1.84 +/- 0.44 cm(2), an d restenosis rate of 22% at 36 months. PTMC is a safe, effective treat ment for symptomatic MS. Results of both IB and DB techniques are simi lar, but the IB is simpler and safer. Long-term clinical improvement i s maintained, although the restenosis rate seems to be progressive and related to inadequate immediate results.