PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY FOR POSTSURGICAL MITRAL RESTENOSIS - ACUTE OUTCOME AND ANALYSIS OF FACTORS INFLUENCING RESULTS

The present study examined the utility of percutaneous transvenous mit ral commissurotomy (PTMC) for post-surgical mitral restenosis (Group I , n = 71 patients), and the factors influencing the outcome of the pro cedure. The results of PTMC were also compared with a group of patient s (Group n, n = 70 patients), who underwent PTMC for de novo mitral st enosis. Both the groups were matched for age, pre-procedure mitral val ve area and echocardiographic score. PTMC was successful in 60 patient s (85%) in group I and in 68 patients (97%) in group II (p < 0.05). Ho wever, the final mitral valve area achieved was similar between the tw o groups (1.8 +/- 0.3 vs. 1.9 +/- 0.2 sq.cm, p = NS). Patients in grou p I had significantly greater mitral valve calcification (0.6 +/- 0.8 vs. 0.3 +/- 0.6, p < 0.05). Multiple regression analysis of results in patients with postsurgical restenosis revealed that only basal mean p ulmonary artery pressure and basal cardiac index correlated significan tly with increase in valve area. Mitral valve Leaflet mobility, thickn ess and subvalvular deformity did not correlate significantly with the increase in mitral valve area. Conclusion. PTMC is a safe procedure f or post-surgical mitral restenosis with negligible complication, with a higher success and significantly lower complication rate than that r eported for repeat surgical commissurotomy. Although patients,vith sur gical restenosis had a greater degree of calcification of mitral valve leaflets; only basal mean pulmonary artery pressure and cardiac index significantly influenced the increase in mitral valve area. Increased fibrosis of mitral leaflet following surgery probably adversely influ ences the results of PTMC for post-surgical mitral restenosis.