Surgical results after failed mitral valve percutaneous dilatation.

Objectives: Percutaneous balloon mitral valve commissurotomy (BMC) is an al ternative to surgical commissurotomy. Complications following BMC includes mitral regurgitation, iatrogenic atrial septal defect, residual mitral sten osis, and pericardial hemorrhage. This study analyzes the outcomes of surge ry following failed BMC for mitral stenosis. Methods : In a series of 298 p atients treated with BMC, 53 patients (17.7%) had a complication that neces sitated a surgical treatment. Twenty-eight patients needed an immediate sur gery before the discharge (group I) and 25 patients were operated on an ele ctive basis (group II). Results. In group I, 27 patients have been operated and one died before the operation. In 21 patients an acute mitral regurgit ation occurred, 3 patients had a residual mitral stenosis, and 3 had a left atrial perforation. The operation consisted of 26 mitral valve replacement s, 20 concomitant reparations of iatrogenic atrial septal defect, and one o pen mitral valve commissurotomy. Operative mortality was 3.7% (1 out of 27) . In group II, 25 patients have been operated at a mean 18 +/- 14 months af ter BMC. In the 25 patients the operation was indicated for significant mit ral regurgitation (2 + and more). The operation consisted of 25 mitral valv e replacements, 9 concomitant reparations of iatrogenic atrial septal defec t, 3 patients had also coronary artery bypasses. The operative mortality wa s 8% (2 out of 25). The echocardiographic score was similar for both groups , it was 8.4 +/- 2.0 in group I and 8.0 +/- 1.5 in group II (P = NS). Despi te these complications following failed BMC, surgery appears a safe procedu re with an acceptable mortality.