Circulation, Vol 80, 782-792, Copyright © 1989 by American Heart Association
M Nobuyoshi, N Hamasaki, T Kimura, H Nosaka, H Yokoi, H Yasumoto, H Horiuchi, H Nakashima, T Shindo and T Mori
Percutaneous transvenous mitral commissurotomy was performed in 106
consecutive patients. Significant symptomatic improvement was achieved in
97 patients (92%). Mean left atrial pressure decreased (from 18 +/- 8 to 11
+/- 8 mm Hg, p less than 0.00001), mean mitral diastolic pressure gradient
decreased (from 12 +/- 7 to 7 +/- 6 mm Hg, p less than 0.00001), and mitral
valve area increased (from 1.40 +/- 0.40 to 2.00 +/- 0.50 cm2, p less than
0.00001). Based on echocardiographic characteristics of the mitral
apparatus, patients were grouped retrospectively in three categories:
pliable (group 1, n = 37), semipliable (group 2, n = 59), and rigid (group
3, n = 10). Clinical success was achieved in 36 patients of group 1 (97%)
and in 55 patients of group 2 (93%). Only six patients in group 3 (60%)
improved symptomatically (p less than 0.001 vs. group 1, p less than 0.001
vs. group 2). The severity of mitral regurgitation increased in five
patients of group 1 (14%), in 12 of group 2 (20%), and in three of group 3
(33%). Six patients had recurrent symptoms at 9 months after
commissurotomy. Recurrence of symptoms was significantly more frequent in
group 3 compared with the other two groups (group 1, 3%; group 2, 4%; and
group 3, 50%; p less than 0.0001 vs. groups 1 and 2). Multiple regression
analysis identified the previously mentioned echocardiographic
characteristics of the mitral apparatus as the significant predictor for
clinical outcome. Thus, percutaneous transvenous mitral commissurotomy can
be considered a safe and effective treatment for patients with pliable
valves. Patients with semipliable or with rigid valves should be selected
for operation very carefully.
ARTICLES
Indications, complications, and short-term clinical outcome of percutaneous transvenous mitral commissurotomy
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
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