CLINICAL FOLLOW-UP OF PATIENTS UNDERGOING PERCUTANEOUS MITRAL BALLOONVALVOTOMY

Background This study is the clinical follow-up (20+/-12 months; range , 6 to 49 months) of 327 patients who had percutaneous mitral balloon valvotomy (PMV) at the Massachusetts General Hospital. Methods and Res ults There were seven in-hospital deaths. Patients were divided into t wo groups according to their echocardiographic score; 211 patients had echocardiographic scores less than or equal to 8 and 116, echocardiog raphic scores >8. Patients with echocardiographic scores >8 were older (64+/-11 versus 48+/-14 years, P<.01), and more had atrial fibrillati on (65% versus 40%, P<.01), calcium under fluoroscopy (81% versus 29%, P<.01), and previous surgical commissurotomy (30% versus 16%, P<.01) than patients with echocardiographic scores less than or equal to 8. W ith PMV, mitral valve area increased from 1.0+/-0.3 to 2.2+/-0.8 cm(2) in patients with echocardiographic scores less than or equal to 8 and from 0.8+/-1 to 1.7+/-0.7 cm(2) in those with echocardiographic score s >8. Rates of survival (98+/-2% versus 72+/-11%), survival with freed om from mitral valve replacement (91+/-4% versus 55+/-13%), and surviv al with freedom from combined events (79+/-10% versus 39+/-18%) at fol low-up were greater in patients with echocardiographic scores less tha n or equal to 8 (P<.00005). Cox regression analysis identified the ech ocardiographic score as the most important unfavorable intermediate lo ng-term follow-up prediction factor after PMV. Conclusions The excelle nt intermediate long-term clinical follow-up of patients with echocard iographic score less than or equal to 8 and no calcified mitral valves suggests that PMV may be the treatment of choice in this group of pat ients.