IMMEDIATE RESULTS OF THE INOUE MITRAL VALVOTOMY IN PATIENTS WITH PREVIOUS SURGICAL MITRAL COMMISSUROTOMY - PRELIMINARY-REPORT

Background: The objective of this study is to evaluate the immediate r esult of the percutaneous mitral valvotomy in patients with previous s urgical mitral commissurotomy, compared with patients considered ideal for the performance of the procedure, Methods: The authors of this pa per compared the immediate results of the percutaneous mitral valvotom y (PMV) performed on two groups of patients. Group I included 20 patie nts who were good candidates for PMV, with an echocardiographic score of less than or equal to 8, without evidence of left atrial thrombus, and with no recent embolic event, Group II included seven patients wit h previous mitral commissurotomy (MC). Results: According to the Wilco xon non-parametric t test analysis, the hemodynamic variables changed significantly in the patients of group I: the mitral area increased fr om 1.21 +/- 0.41 to 2.62 +/- 0.75 cm(2) (P = <0.001); the mean left at rial pressure decreased from 17.2 +/- 7.2 mmHg to 9.2 +/- 4.5 mmHg (P <0,001), and the pressure transmitral gradient decreased 12.4 +/- 6.8 to 3.3 +/- 1.26 mm Hg (P = <0.001), No statistically significant diffe rence in the hemodynamic changes of the patients of group II after the PMV was found: the mitral area increased from 1.2 +/- 0.2353 to 1.96 +/- 0.57 cm(2); the mean left atrial pressure decreased from 17.42 +/- 10.35 to 12.42 +/- 7.3 mmHg, and the pressure mitral gradient decreas ed from 11.47 +/- 6.5 to 5.7 +/- 4.8 mmHg. The mitral area determined by echocardiographic procedure showed the same tendency in patients wi th previous MC, Conclusions: In spite of this tendency, during the fol low-up after PMV the NYHA functional class decreased from II - IV to I in the patients with previous MC, Because a second surgical MC result s in higher mortality, PMV is indicated in patients with previous MC, delaying or avoiding a second MC or valve replacement.