Percutaneous transatrial mitral commissurotomy: Immediate and intermediate results

Objectives. The purpose of this study was to evaluate the immediate and follow-up results of percutaneous transatrial mitral commissurotomy in 600 patients with rheumatic mitral stenosis. Background. Percutaneous transatrial mitral commissurotomy has emerged as an effective nonsurgical technique for patients with symptomatic mitral stenosis. Several studies have shown that the Immediate results are comparable to closed and open mitral valvotomy. Methods. Percutaneous transatrial mitral commissurotomy was performed in 600 patients with rheumatic mitral stenosis by the double-balloon (290 patients [48.3%]) and Row-guided inoue balloon (310 patients [51.7%]) techniques. There were 154 male (25.6%) and 446 female (77.4%) patients with a mean [±SD] age of 27 ± 8 years (range 8 to 60). Atrial fibrillation was present in 26 patients (4.3%), mitral regurgitation ≤ grade 2 in 62 (10.3%) and densely calcific valve in 12 (2%). All patients had clinical and echocardiographic (two-dimensional, continuous wave Doppler, color flow imaging) follow-up at 3-month intervals. Results. Percutaneous transatrial mitral commissurotomy was successful in 589 patients (9S.1%), and optimal commissurotomy was achieved in 562 (93.6%), with an increase in mitral valve area from (mean ± SD) 0.75 ± 0.18 to 2.2 ± 0.38 cm2(p < 0.001) and a decrease in transmitral end-diasiolic gradient front 27.3 ± 6.1 to 3.8 ± 4.2 mm Hg (p < 0.001). Mitral regurgitation developed or increased in 208 patients (34.6%). Six patients (1%) with mitral régurgitation required mitral valve replacement. Cardiac tarnponade occurred in 8 patients (1.3%). Six patients (1%) died. Restenosis developed in 10 patients (1.7%) during a mean follow-up period of 37 ± 8 months (range 6 to 66). Conclusions. Percutaneous transatrial mitral commissurotomy is an effective, safe procedure with gratifying intermediate results. It should be considered the treatment of choice for rheumatic mitral stenosis.