(Circulation. 1999;99:3272-3278.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Late Results of Percutaneous Mitral Commissurotomy in a Series of 1024 Patients
Analysis of Late Clinical Deterioration: Frequency, Anatomic Findings, and Predictive Factors
From the Cardiology Department, Tenon Hospital, Paris, France.
Correspondence to Dr Bernard Iung, Cardiologie, Hopital Tenon, 4, rue de la Chine, 75020 Paris, France. E-mail vahan001{at}wanadoo.fr
Background—The optimal use of percutaneous mitral commissurotomy (PMC) in a wide range of patients requires accurate evaluation of late results and identification of their predictors.
Methods and Results—Late results of PMC were assessed in 1024
patients whose mean age was 49±14 years.
Echocardiography showed that 141 patients (14%)
had pliable valves and mild subvalvular disease, 569 (55%) had
extensive subvalvular disease, and 314 (31%) had
calcified valves. A single balloon was used in 26 patients, a double
balloon in 390, and the Inoue Balloon in 608. Good immediate results
were defined as valve area 
1.5 cm2 without
regurgitation >2/4 (Sellers' grade) and were
obtained in 912 patients. Median duration of follow-up was 49 months.
The 10-year actuarial rate of good functional results (survival with no
cardiovascular death and no need for surgery or repeat
dilatation and in New York Heart Association [NYHA] class I or II)
was 56±4% in the entire population. Follow-up
echocardiography was available in 90% of the
patients who experienced poor functional results after good immediate
results and showed restenosis in 97% of these. In
multivariate analysis, the predictors of poor
functional results were old age (P=0.0008), unfavorable
valve anatomy (P=0.003), high NYHA class
(P<0.0001), atrial fibrillation
(P<0.0001), low valve area after PMC
(P=0.001), high gradient after PMC
(P<0.0001), and grade 2 mitral
regurgitation after PMC (P=0.04).
Conclusions—PMC can be performed with good late results in a variety of patient subsets. Prediction of late events is multifactorial. Knowledge of these predictors can improve patient selection and follow-up.
Key Words: mitral valve • balloon • valvuloplasty • follow-up studies
This article has been cited by other articles:
 |
|
 |
|
  M.-J. Kim, J.-K. Song, J.-M. Song, D.-H. Kang, Y.-H. Kim, C. W. Lee, M.-K. Hong, J.-J. Kim, S.-W. Park, and S.-J. Park Long-Term Outcomes of Significant Mitral Regurgitation After Percutaneous Mitral Valvuloplasty Circulation, December 19, 2006; 114(25): 2815 - 2822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Fawzy, H. Hegazy, M. Shoukri, F. El Shaer, A. ElDali, and M. Al-Amri Long-term clinical and echocardiographic results after successful mitral balloon valvotomy and predictors of long-term outcome Eur. Heart J., August 2, 2005; 26(16): 1647 - 1652. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M E Fawzy, M A Stefadouros, H Hegazy, F E Shaer, M A Chaudhary, and F A Fadley Long term clinical and echocardiographic results of mitral balloon valvotomy in children and adolescents Heart, June 1, 2005; 91(6): 743 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Vassiliades Jr, P. C. Block, L. H. Cohn, D. H. Adams, J. S. Borer, T. Feldman, D. R. Holmes, W. K. Laskey, B. W. Lytle, M. J. Mack, et al. The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI) Endorsed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1554 - 1560. [Full Text] [PDF]
|
|
|
|
 |
|
 American College of Cardiology Foundation (ACCF) a, T. A. Vassiliades Jr, P. C. Block, L. H. Cohn, D. H. Adams, J. S. Borer, T. Feldman, D. R. Holmes, W. K. Laskey, B. W. Lytle, et al. The clinical development of percutaneous heart valve technology: A position statement of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI) J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 970 - 976. [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Vassiliades Jr, P. C. Block, L. H. Cohn, D. H. Adams, J. S. Borer, T. Feldman, D. R. Holmes, W. K. Laskey, B. W. Lytle, M. J. Mack, et al. The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI) Ann. Thorac. Surg., May 1, 2005; 79(5): 1812 - 1818. [Full Text] [PDF]
|
|
|
|
 |
|
 M. I. Turina Future of heart valve surgery Eur. J. Cardiothorac. Surg., December 1, 2004; 26(Suppl_1): S8 - S13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Nakajima, J. Kobayashi, K. Bando, Y. Yasumura, S. Nakatani, K. Kimura, K. Niwaya, O. Tagusari, and S. Kitamura Consequence of atrial fibrillation and the risk of embolism after percutaneous mitral commissurotomy: The necessity of the maze procedure Ann. Thorac. Surg., September 1, 2004; 78(3): 800 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Vahanian and I. F. Palacios Percutaneous Approaches to Valvular Disease Circulation, April 6, 2004; 109(13): 1572 - 1579. [Full Text] [PDF]
|
|
|
|
|
|
B. Iung, A. Nicoud-Houel, O. Fondard, H. Akoudad, T. Haghighat, E. Brochet, E. Garbarz, B. Cormier, G. Baron, P. Luxereau, et al. Temporal trends in percutaneous mitral commissurotomy over a 15-year period Eur. Heart J., April 2, 2004; 25(8): 701 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Turgeman, S. Atar, and T. Rosenfeld The Subvalvular Apparatus in Rheumatic Mitral Stenosis: Methods of Assessment and Therapeutic Implications Chest, November 1, 2003; 124(5): 1929 - 1936. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Gamra, F Betbout, K Ben Hamda, F Addad, F Maatouk, Z Dridi, S Hammami, M Abdellaoui, H Boughanmi, T Hendiri, et al. Balloon mitral commissurotomy in juvenile rheumatic mitral stenosis: a ten-year clinical and echocardiographic actuarial results Eur. Heart J., July 2, 2003; 24(14): 1349 - 1356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Rahimtoola, A. Durairaj, A. Mehra, and I. Nuno Current Evaluation and Management of Patients With Mitral Stenosis Circulation, September 3, 2002; 106(10): 1183 - 1188. [Full Text] [PDF]
|
|
|
|
|
|
B. Iung, C. Gohlke-Barwolf, P. Tornos, C. Tribouilloy, R. Hall, E. Butchart, and A. Vahanian Recommendations on the management of the asymptomatic patient with valvular heart disease Eur. Heart J., August 2, 2002; 23(16): 1253 - 1266. [PDF]
|
|
|
|
|
|
B D Prendergast, T R D Shaw, B Iung, A Vahanian, and D B Northridge Contemporary criteria for the selection of patients for percutaneous balloon mitral valvuloplasty Heart, May 1, 2002; 87(5): 401 - 404. [Full Text] [PDF]
|
|
|
|
|
|
Y. Boudjemline and P. Bonhoeffer Steps Toward Percutaneous Aortic Valve Replacement Circulation, February 12, 2002; 105(6): 775 - 778. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Vahanian VALVE DISEASE: Balloon valvuloplasty Heart, February 1, 2001; 85(2): 223 - 228. [Full Text]
|
|
|
|
|
|
A. Vahanian and B. Iung Percutaneous mitral balloon commissurotomy: a useful and necessary treatment for the western population Eur. Heart J., October 2, 2000; 21(20): 1651 - 1652. [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
T. O. Cheng, C. R. Chen, B. Iung, E. Garbarz, P. Michaud, S. Helou, B. Farah, P. Berdah, P.-L. Michel, B. Cormier, et al. Late Results of Percutaneous Balloon Mitral Valvuloplasty: The Chinese Experience Response Circulation, July 11, 2000; 102 (2): e18 - e18. [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]
|
|