PERCUTANEOUS TRANSATRIAL MITRAL COMMISSUROTOMY - IMMEDIATE AND INTERMEDIATE RESULTS

Objectives. The purpose of this study was to evaluate the immediate an d follow up results of percutaneous transatrial mitral commissurotomy in 600 patients with rheumatic mitral stenosis. Background. Percutaneo us transatrial mitral commissurotomy has emerged as an effective nonsu rgical technique for patients with symptomatic mitral stenosis. Severa l studies have shown that the immediate results are comparable to clos ed and open mitral valvotomy. Methods. Percutaneous transatrial mitral commissurotomy was performed in 600 patients with rheumatic mitral st enosis by the double-balloon (290 patients [48.3%]) and flow-guided In oue balloon (310 patients [51.7%]) techniques. There were 154 male (25 .6%) and 446 female (77.4%) patients with a mean [+/-SD] age of 27 +/- 8 years (range 8 to 60). Atrial fibrillation was present in 26 patien ts (4.3%), mitral regurgitation less than or equal to grade 2 in 62 (1 0.3%) and densely calcific valve in 12 (2%). All patients had clinical and echocardiographic (two-dimensional, continuous wave Doppler, colo r flow imaging) follow-up at 3-month intervals. Results. Percutaneous transatrial mitral commissurotomy was successful in 589 patients (98.1 %), and optimal commissurotomy was achieved in 562 (93.6%), with an in crease in mitral valve area from (mean +/- SD) 0.75 +/- 0.18 to 2.2 +/ - 0.38 cm(2) (p < 0.001) and a decrease in transmitral end-diastolic g radient from 27.3 +/- 6.1 to 3.8 +/- 4.2 mm Hg (p < 0.001). Mitral reg urgitation developed or increased in 208 patients (34.6%). Six patient s (1%) with mitral regurgitation required mitral valve replacement. Ca rdiac tamponade occurred in 8 patients (1.3%). Six patients (1%) died. Restenosis developed in 10 patients (1.7%) during a mean follow up pe riod of 37 +/- 8 months (range 6 to 66). Conclusions. Percutaneous tra nsatrial mitral commissurotomy is an effective, safe procedure with gr atifying intermediate results. It should be considered the treatment o f choice for rheumatic mitral stenosis.