This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Davidson, C. J. Articles by Davis, K. Search for Related Content PubMed PubMed Citation Articles by Davidson, C. J. Articles by Davis, K.

Circulation, Vol 86, 91-99, Copyright © 1992 by American Heart Association

ARTICLES

Balloon mitral commissurotomy after previous surgical commissurotomy. The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry participants

CJ Davidson, TM Bashore, M Mickel and K Davis
National Heart, Lung, and Blood Institute, Bethesda, Md.

BACKGROUND. Mitral restenosis after surgical mitral commissurotomy often occurs within 5-15 years, necessitating a repeat procedure. Balloon mitral commissurotomy (BMC) has been advocated as an alternative to repeat surgery for mitral restenosis. METHODS AND RESULTS. The purposes of this study are to determine the short- and intermediate-term outcomes of patients undergoing BMC after previous surgical commissurotomy, to compare these patients with those undergoing balloon mitral commissurotomy as an initial procedure, and to elucidate the multivariate determinants of acute procedural and clinical outcome. Of 738 patients undergoing BMC as part of the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry, 133 underwent BMC after previous surgical mitral commissurotomy. Prospective data obtained included demographic, hemodynamic, echocardiographic, and clinical follow-up. BMC after previous surgical commissurotomy produced a significant reduction in transvalvular gradient from 13 +/- 5 to 6 +/- 3 mm Hg (p less than 0.0001) and an increase in mitral valve area from 1.0 +/- 0.3 to 1.8 +/- 0.8 cm2 (p less than 0.0001). BMC as an initial procedure increased valve area from 1.0 +/- 0.4 to 2.0 +/- 0.8 cm2 (p less than 0.0001) (p = 0.03 versus prior surgery). Baseline characteristics including mitral valve echo score were similar for both groups. Comparing 6-month status in patients with prior surgery to those without, 80% versus 90% were New York Heart Association (NYHA) functional class I or II (p = 0.004). Mortality was similar. In patients with previous mitral valve surgery, multivariate predictors of improvement in 6-month clinical status included the experience of the center (p = 0.006), lower echocardiographic score (p = 0.001), and lower left ventricular end- diastolic pressure (p = 0.008). Multivariate determinants of a final mitral valve area greater than or equal to 1.5 cm2 were a lower baseline NYHA functional class (p = 0.003) and lower mitral valve echocardiographic score (p = 0.008). CONCLUSIONS. BMC after previous surgical mitral commissurotomy results in similar hemodynamic changes as in patients undergoing BMC as an initial procedure. Symptomatic improvement at 6 months is slightly less frequent in prior commissurotomy patients. Patients with favorable valvular morphology and preserved left ventricular function who undergo BMC in experienced centers are most likely to achieve symptomatic improvement after previous surgical commissurotomy. In general, BMC is an effective treatment for mitral restenosis after previous surgical commissurotomy.

This article has been cited by other articles:

				B Iung, E Garbarz, P Michaud, O Fondard, S Helou, J Kamblock, P Berdah, P.-L Michel, P Lionet, B Cormier, et al. Immediate and mid-term results of repeat percutaneous mitral commissurotomy for restenosis following earlier percutaneous mitral commissurotomy Eur. Heart J., October 2, 2000; 21(20): 1683 - 1689. [Abstract] [PDF]

				B. Iung, E. Garbarz, P. Michaud, A. Mahdhaoui, S. Helou, B. Farah, P. Berdah, P.-L. Michel, Y. Makita, B. Cormier, et al. Percutaneous mitral commissurotomy for restenosis after surgical commissurotomy: Late efficacy and implications for patient selection J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1295 - 1302. [Abstract] [Full Text] [PDF]

				M. N. Leon, L. C. Harrell, H. F. Simosa, N. A. Mahdi, A. Pathan, J. Lopez-Cuellar, I. Inglessis, P. R. Moreno, and I. F. Palacios Mitral balloon valvotomy for patients with mitral stenosis in atrial fibrillation: Immediate and long-term results J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1145 - 1152. [Abstract] [Full Text] [PDF]

				I. F. Palacios, P. L. Sanchez, L. C. Harrell, A. E. Weyman, and P. C. Block Which Patients Benefit From Percutaneous Mitral Balloon Valvuloplasty?: Prevalvuloplasty and Postvalvuloplasty Variables That Predict Long-Term Outcome Circulation, March 26, 2002; 105(12): 1465 - 1471. [Abstract] [Full Text] [PDF]