LATE CLINICAL AND ECHOCARDIOGRAPHIC FOLLOW-UP AFTER PERCUTANEOUS BALLOON DILATATION OF THE MITRAL-VALVE - ABSTRACTS

Objective-To assess the outcome after attempted percutaneous balloon d ilatation of the mitral valve in patients with severe mitral stenosis between February 1986 and June 1992. Design-Clinical state, mitral val ve area, and restenosis at follow up were analysed. Mitral valve area as determined by the Gorlin formula, planimetry, and Doppler methods w as compared before and after dilatation and at follow up. Setting-Univ ersity hospital. Patients-176 patients had serial clinical and Doppler echocardiographic follow up and 44 of them also underwent recatheteri sation. Result-At follow up 93% of patients were in New York Heart Ass ociation functional class I or class II. Mitral valve area (planimetry ) increased from 0.97(0.24) cm(2) before to 1.86(0.39) cm(2) after dil atation (p = 0.0001) and then decreased to 1.72(0.39) cm(2) at follow up (p < 0.001); mitral valve area (Doppler) increased from 1.01 (0.24) to 1.89 (0.42) cm(2) (p = 0.0001) and then decreased to 1.78(0.40) cm (2) (p < 0.05). The overall restenosis rate was 15% and over 90% of th e patients were free from cardiovascular events. Age, valvar calcifica tion, echocardiographic score, and mitral valve area after dilatation were found to be determinant predictors of restenosis. In patients who underwent recatheterisation, mitral valve area by the Gorlin method a t follow up was comparable with that by planimetry and Doppler methods whereas a significant discrepancy between the three methods was noted immediately after dilatation. Conclusion-Balloon dilatation of the mi tral valve provided sustained anatomical and functional improvement in over 80% of patients at late follow up. Older age, heavy calcificatio n, high echocardiographic score, and suboptimal immediate results are significant predictors of restenosis. Doppler echocardiographic examin ation is the procedure of choice for follow up evaluation.