URGENT EMERGENT PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY

Urgent/emergent percutaneous transvenous mitral commissurotomy (PTMC) was performed in 10 patients (two men and eight women, aged 21 to 60 y r). All patients had arterial hypoxemia and four required mechanical r espirators. PTMC was performed in the semi-recumbent position in four patients. The seven patients with pliable valves (group 1) achieved go od hemodynamic and echocardiographic results after PTMC, but one died 2 wk later because of sepsis complicating preexisting pneumonitis. The two pregnant patients uneventfully delivered normal babies at term. T here was continued clinical improvement in the six surviving patients at last follow-up at 11 to 39 mon (median 26). Of the three patients w ith calcified valves and severe subvalvular lesions (group 2), the pre moribund patient in whom last-resort PTMC created severe mitral regurg itation died 3 days later of multiple organ failure. The other two pat ients underwent mitral valve replacement 1-6 days later because of lac k of clinical improvement due to creation of severe mitral regurgitati on and ineffective mitral valve dilation, respectively. In conclusion, urgent/emergent PTMC is feasible and safe. However, its outcomes are dictated by the status of diseased mitral valve and coexisting illness . (C) 1994 Wiley-Liss, Inc.