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Percutaneous balloon mitral valvuloplasty (PBMV) should be considered as the first-line therapy in most patients with mitral valve stenosis.
To evaluate acute clinical, hemodynamic, echocardiographic, and long-term outcomes of PBMV in patients with a previous closed mitral commissurotomy (CMC).
Twenty-one rheumatic mitral stenosis patients with histories of CMC were studied between 1994 and 2010. The PBMV was performed with an Inoue balloon, and the ideal balloon size was measured according to the patient's height. All patients underwent standard transesophageal (TEE) and transthoracic (TTE) echocardiographic examinations before and after the PBMV. Follow-up was scheduled every 6 months during the first year, and yearly thereafter.
The PBMV was successful in all of the patients (mean age 44.86±6.48 years). The Wilkins score was 8.95±1.687, and the procedure time was 30.21±10.23 minutes, with a mean of 2.45±1.14 for the balloon inflation. The baseline characteristics are shown in Table 1. After the procedure, the post-PBMV mitral valve area (MVA) was significantly larger, with a low mean transmitral gradient (MVA 1.20±0.25 vs. 1.82±0.33 p<0.01, mean transmitral gradient 12.10±5.54 vs. 5.81±2.31 p<0.01). The pulmonary capillary wedge pressure (PCWP) significantly decreased after PBMV (25.62±8.6 vs. 13.95±6.87, p<0.01). The duration of follow-up was 83.4±39.5 months, and there were no mortalities. Five patients of 21 underwent mitral valve replacement (MVR), and one had a second PBMV due to restenosis. At the final follow-up appointment, the resting MVA was 1.57±0.47 cm2, and the mean transmitral gradient was 8.33±4.45 mmHg.
PBMV is an effective therapy, with excellent immediate results in patients with previous CMCs; however, long-term results revealed more restenosis than expected. Additionally, the need for MVR was high.
|Mean transmitral gradient(mmHg)||12.1±5.54|
NYHA:New York Heart Association MVA:Mitral valve area