(Circulation. 1995;91:671-676.)
© 1995 American Heart Association, Inc.
Articles |
Clinical Follow-up of Patients Undergoing Percutaneous Mitral Balloon Valvotomy
From the Department of Medicine (Cardiac Unit), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Correspondence to Igor F. Palacios, MD, Director of Interventional Cardiology, Massachusetts General Hospital, Boston, MA 02114.
Background This study is the clinical follow-up (20±12 months; range, 6 to 49 months) of 327 patients who had percutaneous mitral balloon valvotomy (PMV) at the Massachusetts General Hospital.
Methods and Results There were seven in-hospital deaths. Patients
were divided into two groups according to their echocardiographic
score; 211 patients had echocardiographic scores 
8 and 116,
echocardiographic scores >8. Patients with echocardiographic scores
>8 were older (64±11 versus 48±14 years, P<.01),
and
more had atrial fibrillation (65% versus 40%, P<.01),
calcium under fluoroscopy (81% versus 29%, P<.01), and
previous surgical commissurotomy (30% versus 16%, P<.01)
than patients with echocardiographic scores 8. With PMV, mitral valve
area increased from 1.0±0.3 to 2.2±0.8 cm2 in
patients
with echocardiographic scores 8 and from 0.8±1 to 1.7±0.7
cm2 in those with echocardiographic scores >8. Rates of
survival (98±2% versus 72±11%), survival with freedom from
mitral
valve replacement (91±4% versus 55±13%), and survival with
freedom
from combined events (79±10% versus 39±18%) at follow-up were
greater in patients with echocardiographic scores 8
(P<.00005). Cox regression analysis identified the
echocardiographic score as the most important unfavorable intermediate
long-term follow-up prediction factor after PMV.
Conclusions The excellent intermediate long-term clinical
follow-up of patients with echocardiographic score 8 and no calcified
mitral valves suggests that PMV may be the treatment of choice in this
group of patients.
Key Words: stenosis • mitral valve • follow-up studies
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