RESULTS OF PERCUTANEOUS TRANSSEPTAL MITRAL COMMISSUROTOMY IN PATIENTS40 YEARS AND ABOVE WITH THOSE UNDER 40 YEARS OF AGE - IMMEDIATE AND 5-YEAR FOLLOW-UP RESULTS

Patients with mitral stenosis in Western countries are relatively old. It is anticipated that percutaneous transseptal mitral commissurotomy (PTMC) may have more complications and may not be as effective in thi s group of patient as in younger patients due to more calcification an d fibrosis of the mitral valve. We analysed the clinical, hemodynamic, echocardiographic data in 296 consecutive patients divided prospectiv ely into two groups; group 1 consisted of 184 patients greater-than-or -equal-to 40 years and group 2 of 112 patients < 40 years coming mostl y from developing countries. The immediate gain in valve area was 2.18 +/- 0.61 cm2 in group 1 vs. 2.31 +/- 0.65 cm2 in group 2 (P = ns). Th e incidence of acute regurgitation requiring surgical intervention was similar in both groups. Follow-up data up to 5 years after PTMC was a vailable in 170 patients (92.4%) in group 1 (mean 20 +/- 13 months) an d 83 patients (74.1%) in group 2 (mean 29 +/- 17 months). Restenosis b y Doppler method (valve area less than 1.5 cm2 with loss of at least 5 0% initial gain in valve area) was found in 33 patients in group 1 (29 .2%) vs. 11 (14.9%) in group 2 (P < 0.05). Events free from death, nee d for mitral valve replacement or repeat PTMC at 5 year follow-up was 76% in group 1 vs. 87% in group 2 (P < 0.05). We conclude that the imm ediate effectiveness and acute complications of PTMC in patients 40 ye ars and above are comparable to younger patients. Restenosis is clearl y higher and there is a trend towards need for mitral valve replacemen t in patients 40 years and above at follow-up. However, the continuing benefit for the majority of the patients 40 years and above (76% free from adverse events) would suggest that PTMC is an appropriate treatm ent modality even in the older patients. (C) 1994 Wiley-Liss, Inc.