PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY - IMMEDIATE AND LATE RESULTS IN 300 PATIENTS

Between December 1987 and July 1992, we performed a balloon mitral val vuloplasty to 300 patients aged 48 +/- 23 years, with pure or predomin ant, symptomatic mitral stenosis, with an hemodynamic area < 1.5 cm2 a nd a mean echocardiographic score of 8.8 +/- 1. 3 (6-13). Young subjec ts with mobile and flexible valves as well as elders with highly damag ed valves were included. A transeptal technique employing 2 balloons w as used in 97% of cases. There were 3 failures and 9 deficient results . In 284 patients, the procedure was considered successful with a mean increase in mitral area (measured using modified Gorlin's formula) fr om 0.88 +/- 0. 13 to 2.19 +/- 0.38 cm2. Four patients died two due to a left ventricular traumatism, one due to an irreversible low cardiac output and one due to a massive systemic embolism. In five, a cardiac tamponade was treated with pericardiocentesis or surgery. One hundred patients were followed for a mean of 40 +/- 3 months. Mitral areas rem ained over 1.5 cm2 in 87% and 14 had a significant reestenosis. The la tter had an initial echocardiographic score over 8 or previous surgica l commissurotomy. Multifactorial analysis identified valvular motility and global echocardiographic scores as predictors of immediate succes s. Likewise, the last parameter and subvalvular thickening were predic tors of late reestenosis and of increase in mitral regurgitation post valvuloplasty. According to our experience, percutaneous balloon mitra l valvuloplasty is a first choice therapeutic alternative in patients with mitral stenosis.