Percutaneuos transluminal valvotomy in mitral stenosis

pp 260-267

Abstract

Balloon percutaneous transluminal valvotomy (PTV) was attempted in 16 patients with mitral stenosis (MS) (12 rheumatic, 4 congenital) and was successfully completed in 13 (81%). In the 3 patients in whom PTV could not be performed the causes were accidental perforation of the aorta, technical impossibility in a parachute mitral valve, and death secondary to a vagal reflex following the transeptal catheterization in a 2 year old girl with severe MS. In the other patients the mean age was 38.2 ± 16.1 years (range 3-63). The procedure was performed through an anterograde venous access in 10 and retrograde arterial in 3. A single balloon was used in 5 patients and 2 balloons in the remaining. The left atrial mean pressure and the transmitral pressure gradient decreased from 25.2±5.8 to 12.1±4.5 (P< 0.001) and from 15.8±6.2 to 4.7±2.8 mmHg (P <. 0.001) respectively. The mitral valve area in cm2 calculated by hemodynamics and Doppler increased from 0.88±0.28 to 2.32±1.67 (P<0.02) and from 1.01±0.35 to 1.73±0.44 (P < 0.001) respectively. The functional class before PTV was grade 3 and improved to grade 1, 2 in the follow-up. There was no increase or appearance of new mitral regurgitation. Five patients had evidence of a small atrial septal defect. One patient developed transient facial paresis. There was only one mitral restenosis in a patient dilated with a single balloon. It is concluded that PTV in MS is an effective procedure with similar results to those obtained by surgery.