Percutaneous mechanical mitral commissurotomy with the metallic valvulotome: Detailed technical aspects and overview of the results of the multicenter registry on 882 patients

Percutaneous mechanical mitral commissurotomy (PMMC) is a new technique tha t has been developed over the last 3 years for the treatment of mitral sten osis. The device used opens the commissures by a direct action of two paral lel bars located in a metallic head screwed at the distal end of a 13Fr cat heter. Opening of the bars is obtained with the use of activating pliers at tached at the proximal end of the catheter. The metallic dilator and the pl iers can be safely reused after sterilization. The device and the different steps of the procedure are detailed in this article. The results of an int ernational registry including 882 patients are reported here. PMMC could be achieved in 863 (98%) cases. Maximal opening of the bars was 40 mm in 90% of the cases. The technique resulted in an increase of the mitral valve are a from 0.94 +/- 0.2 cm(2) to 2.12 +/- 0.4 cm(2). Bilateral splitting of the commissures was achieved in 85% of the cases. Complications occurred in 33 (3.7%) patients: pericardial tamponade in 1.4% (12 cases, one death), mitr al regurgitation > grade 2 in 2.1% (18 cases, surgery required in 4), and t ransient stroke in 0.3% (3 patients). The role of the learning curve in the occurrence of complications has been clearly demonstrated The cost of the procedure has been markedly decreased in developing countries due to multip le reuses of the device after sterilization.