PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY USING INOUE BALLOON INCHILDREN LESS-THAN 12 YEARS

Rheumatic mitral stenosis in some parts of the world afflicts even you ng children. Percutaneous transvenous mitral commissurotomy (PTMC) usi ng Inoue balloon in these children is not well reported. Forty-five ch ildren (aged 7-12 years, mean 11.0 +/- 1.2 years) with severe rheumati c mitral stenosis (mitral valve area [MVA] 0.64 +/- 0.14 cm(2)) underw ent PTMC. The pulmonary artery wedge pressure (PAW) decreased from 24. 3 +/- 8.6 to 14.7 +/- 7.2 mmHg (P < 0.0001) and mean diastolic gradien t decreased from 24.3 +/- 7.7 to 7.9 +/- 5.9 mmHg with the final MVA o f 1.63 +/- 0.45 cm(2) (P < 0.0001), Complications included significant mitral regurgitation (MR) in three children and atrial shunting in tw o patients, No procedural death, systemic embolism, and cardiac tampon ade were encountered. Twenty-four children had maximum balloon size (M BS) same as recommended balloon size (RES) derived according to the he ight (group I) and 21 children had MBS 1-3 mm less than RES (group II) , Despite the lesser maximum balloon size, the final results were comp arable in both groups (MVA group 1.66 +/- 0.44 vs. group II 1.61 +/- 0 .48 P = NS). The incidence of significant MR (2 and 1 in group I and g roup II, respectively) was similar, On follow-up of 20.4 +/- 16.3 mont hs (range 3-56 months), one child developed restenosis. We conclude th at PTMC is safe and effective in children less than 12 years of age. H owever, the smaller balloon size than the RES derived from height may be equally effective and possibly safer. (C) 1998 Wlley-Liss, Inc.