Percutaneous transseptal mitral valvotomy - progress report

Background: Percutaneous transseptal mitral valvotomy (PTMV) has been estab lished as an alternative to surgery in the treatment of mitral stenosis. Aim: To review our experience in the first 200 attempted PTMV procedures in patients with mitral stenosis, and the short and medium term follow-up. Me thods: PTMV was attempted on 200 occasions in 189 patients with significant mitral stenosis between May 1988 and May 1994. There were 156 females and 33 males, mean age 53.5 years (range 14 to 83 years). Six patients were pre gnant at the time of the procedure. Results: Valve split was achieved at the initial attempt in 183/189 procedu res (97%). Clinical improvement of at least one New York Heart Association (NYHA) functional class was achieved in 172/189 patients (91%). The mean mi tral valve gradient (mean+/-SD) decreased from 15.5+/-5.1 mmHg to 4.9+/-4.1 mmHg, mean cardiac output rose from 3.9+/-1.1 L/minute to 4.4+/-1.4 L/minu te and mean calculated mitral valve area increased from 1.0+/-0.3 cm(2) to 2.1+/-0.9 cm(2). Ten patients developed clinically significant mitral incom petence requiring surgical mitral valve replacement. There were two transie nt cerebral embolic events. Small atrial septal defects were detected echoc ardiographically in 42 patients, but none has been a clinical problem. Ther e were no early deaths; there were 11 late deaths, four of which were non-c ardiac. Twenty patients have had repeat PTMV for re-stenosis, four to 67 mo nths after the first. Conclusions: PTMV provides significant haemodynamic and clinical improvemen t with low risk and should be considered the treatment of choice in patient s with mitral stenosis.