A SERIOUS COMPLICATION OF PERCUTANEOUS MITRAL VALVULOPLASTY - SYSTEMIC EMBOLISM - HOW CAN WE DECREASE IT

Systemic embolism is a potential and severe complication of percutaneo us balloon mitral valvuloplasty (PBMV). The incidence of systemic embo lism during PBMV has been reported to be less than 5% and only 0.6% wi th the Inoue technique. This is less than that reported in closed comm issurotomy series and about the same as in open commissurotomy. In the authors' series of 50 cases, the incidence of systemic embolism was 2 % (1 case). The patient had mitral restenosis (after closed commissuro tomy) with mild to moderate valvular and subvalvular calcification, an d cerebral embolism occurred during the procedure. To prevent systemic embolism, the authors' standard policy was to perform transesophageal echocardiography (TEE), computed tomography, and magnetic resonance i maging before the procedure and to give heparin during the procedure a nd two months preceding it in cases with atrial fibrillation or with a history of previous embolism and to limit manipulation of the cathete r in the left atrium. The authors believe that a close scrutiny in the selection of patients, improved technology of the dilating system, go od experience with PBMV, and adequate heparinization are also of great importance in the prevention of thromboembolic complications.