PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY USING INOUE CATHETER IN JUVENILE RHEUMATIC MITRAL-STENOSIS

Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue ball oon was performed in 270 patients with rheumatic mitral stenosis. Of t hese 81 (27%), 48 males and 33 females, had juvenile mitral stenosis ( age <20 years, range 9-20 years mean 14 +/- 5). All patients were symp tomatic (New York Heart Association [NYHA] class III in 61 patients an d class IV in 20 patients). Following PTMC, the mitral valve area (MVA ) increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 cm(2) (P<0.001) and the ca rdiac index increased from 2.4 +/- 0.8 to 3.0 +/- 0.8 L/min/m(2) (P<0. 001). Mean transmitral gradients decreased from 24 +/- 8 to 4 +/- 3 mm Hg (P<0.001). Three (4%) patients had an increase in mitral regurgita tion by 1 grade (grade 2/4); however, none required surgery. Significa nt left to right atrial shunt (Qp/Qs > 1.3 : 1) on oximetry was detect ed in 8 (10%) patients. Overall results were compared to those with ad ult subgroup of patients with rheumatic mitral stenosis (n = 189, 100 females and 89 males), who underwent PTMC simultaneously. Their age ra nged from 21 to 44 years (mean 32 +/- 11 years). The percentage increa se in MVA was higher in juvenile as compared to adult patients (172 +/ - 61 vs. 154 +/- 69, respectively, P<0.01). A larger final MVA was ach ieved in the juvenile group (2.2 +/- 0.5 vs. 1.9 +/- 0.3 cm(2), P<0.05 ). However, the incidence of increase in mitral regurgitation by 1 gra de was similar in two groups (6% vs. 4%, P = NS). Better outcome of PT MC in juvenile mitral stenosis was attributed to less subvalvular fibr osis, assessed angiographically, as compared to adult patients (subval vular distance ratio 0.20 +/- 0.03 vs. 0.16 +/- 0.04, respectively, P< 0.01). Our results indicate that PTMC using Inoue balloon is an effect ive and safe nonsurgical treatment for the management of juvenile rheu matic mitral stenosis. (C) 1994 Wiley-Liss, Inc.