IMMEDIATE AND LATE OUTCOME OF PERCUTANEOUS BALLOON MITRAL VALVOTOMY IN PATIENTS WITH SIGNIFICANTLY CALCIFIED VALVES

We assessed immediate and late outcome in 55 patients with significant ly calcified valves (group 1) after balloon mitral valvotomy and compa red the results with those from 60 patients with noncalcified or minim ally calcified valves (group 2), After valvotomy, mitral valve area in creased from 1.03 +/- 0.30 cm(2) to 1.64 +/- 0.35 cm(2) (p = 0.0001) b y echo planimetry in group 1 but was significantly smaller than the mi tral valve area in group 2 after valvotomy (1.94 +/- 0.38 cm(2); p = 0 .0001). At a mean follow-up period of 30 months (range 2 to 81 months) , 51% of patients in group 1 and 83% in group 2 were symptom free (p = 0.0002), In group 2, 15 (27%) patients and in group 2, 4 (7%) patient s had cardiac events (p = 0.003). The risk ratio for cardiac events wa s 4.3 times greater in group 1 than in group 2. In group 1, the risk r atio for cardiac events was 3.2 times higher in patients age greater t han or equal to 65 years and in patients with atrial fibrillation. The 6-year cumulative cardiac event-free survival rate was 64% in group 1 and 90% in group 2 (p = 0.005). In 75 (65%) patients who had follow-u p echocardiographic study (35 in group 1 and 40 in group 2), mitral va lve area decreased to 1.48 +/- 0.42 cm(2) at follow-up in group 1 (p < 0.01) and to 1.77 +/- 0.50 cm(2) in group 2 (p = 0.3), Restenosis occ urred in 16 (46%) of 35 patients in group 1 and 10 (25%) of 40 in grou p 2 (p = 0.06), We conclude that significant valve calcification affec ts the immediate results of balloon mitral valvotomy and greatly incre ases the risk of later cardiac events. However, more than half of such patients may still derive long-term benefits from balloon mitral valv otomy, especially if they are young and have normal sinus rhythm.