PERCUTANEOUS INOUE-BALLOON MITRAL COMMISSUROTOMY IN PATIENTS WITH COEXISTING MODERATE MITRAL REGURGITATION, AND SEVERE SUBVALVULAR DISEASE AND OR MITRAL CALCIFICATION/

The present study examined the safety and immediate and late outcome o f 12 patients with coexisting moderate (angiographic grade 2+) mitral regurgitation and significant subvalvular disease and/or calcified mit ral valves (group 1) after percutaneous balloon mitral commissurotomy (BMC) and compared the results with 64 patients without these adverse valve features (group 2). BMC produced a significantly smaller echocar diographically determined mitral valve area improvement in group 1 com pared with group 2 (from 0.7 +/- 0.2 cm(2) to 1.3 +/- 0.3 cm(2) vs. 0. 8 +/- 0.2 cm(2) to 1,7 +/- 0.4 cm(2), respectively, p < 0.05). Similar ly, compared with group 2, less patients in group 1 obtained an optima l valvuloplasty outcome defined as a greater than or equal to 50% incr ease in mitral valve area or a final valve area of greater than or equ al to 1.5 cm(2) without final greater than or equal to 3 grade angiogr aphic mitral regurgitation (75% vs. 95%, p < 0.05). There was, however , no severe (greater than or equal to angiographic grade 3+) mitral re gurgitation in group 1 compared with 1 in group 2 (p = NS). At a mean follow-up of 19 +/- 14 months, there were no deaths or strokes. Resten osis was noted in 4 patients; 3 in group 1, and 1 in group 2. We concl ude that BMC is safe and effective in patients with pre-existing moder ate mitral regurgitation and severe subvalvular disease and/or signifi cant mitral calcification with minimal risk of creating severe mitral regurgitation. The valve area improvement was, however, substantially smaller and the restenosis rate higher than those without moderate mit ral regurgitation and favorable valve anatomy.