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 Google Scholar Google Scholar Articles by Cheng, T. O. Articles by Vahanian, A. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O. Articles by Vahanian, A. Related Collections Valvular heart disease Catheter-based coronary and valvular interventions: other Echocardiography CV surgery: valvular disease

(Circulation. 2000;102:e18.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Late Results of Percutaneous Balloon Mitral Valvuloplasty: The Chinese Experience

Tsung O. Cheng, MD

Professor of Medicine George Washington University, Washington, DC

Chuan Rong Chen, MD

President, Guangdong Society of Interventional Cardiology Guangzhou, People’s Republic of China

	Introduction

Top Introduction References Introduction  References

 
To the Editor:

We are writing in support of the conclusions reached by Iung et al¹ concerning the late results of percutaneous balloon mitral valvuloplasty (PBMV).

The French experience confirmed the Chinese experience that was reported earlier with a larger number of patients, namely, a PBMV can be performed with good late results in a variety of patient subsets.^{2 3} The Inoue balloon technique, which the Chinese investigators have used since November 1985⁴ and the French investigators began using more recently, is the procedure of choice for the treatment of mitral stenosis.⁵

We also found that a hemodynamic evaluation did not provide any information additional to that from clinical and echocardiographic examinations. For this reason and to simplify the procedure to make its use more widespread, the Chinese physicians have not performed systematic hemodynamic measurements before or after PBMV for the last several years. In China, >18 000 PBMVs have been performed to date.

	References

Top Introduction References Introduction  References

 

1. Iung B, Garbarz E, Michaud P, et al. Late results of percutaneous mitral commissurotomy in a series of 1024 patients: analysis of late clinical deterioration: frequency, anatomic findings, and predictive factors. Circulation. 1999;99:3272–3278.[Abstract/Free Full Text]
   
2. Chen C, Cheng TO, for the Multicenter Study Group. Percutaneous balloon mitral valvuloplasty using Inoue technique: a multicenter study of 4832 patients in China. Am Heart J. 1995;129:1187–1204.
   
3. Chen C-R, Cheng TO, Chen J-Y, et al. Long-term results of percutaneous balloon mitral valvuloplasty for mitral stenosis: a follow-up study to 11 years in 202 patients. Cathet Cardiovasc Diagn. 1998;43:132–139.[Medline] [Order article via Infotrieve]
   
4. Chen C, Lo Z, Huang Z, et al. Percutaneous transseptal balloon mitral valvuloplasty: the Chinese experience in 30 patients. Am Heart J. 1988;115:937–947.[Medline] [Order article via Infotrieve]
   
5. Cheng TO, Holmes DR Jr. Percutaneous balloon mitral valvuloplasty by the Inoue balloon technique: the procedure of choice for treatment of mitral stenosis. Am J Cardiol. 1998;81:624–628.[Medline] [Order article via Infotrieve]
   

Response

Bernard Iung, MD; Eric Garbarz, MD; Pierre Michaud, MD; Steeven Helou, MD; Bruno Farah, MD; Patricia Berdah, MD; Pierre-Louis Michel, MD; Bertrand Cormier, MD; Alec Vahanian, MD

Cardiology Department, Tenon Hospital, Paris, France

	Introduction

Top Introduction References Introduction  References

 
We thank Drs Cheng and Chen for their comments concerning our article, "Late Results of Percutaneous Mitral Commissurotomy in a Series of 1024 Patients. Analysis of Late Clinical Deterioration: Frequency, Anatomical Findings, and Predictive Factors."^R1

Despite the absence of large randomized trials comparing the Inoue and double-balloon techniques, the Inoue technique is now the most widely used technique worldwide, mostly because of its ease of use and safety. A low rate of events can be accurately assessed only in reports based on large populations, and the consistency between the experiences in China, the United States, and Europe attests to the high level of safety achieved with the Inoue technique, even when used by a variety of operators. Another way to increase safety is to simplify the procedure. This is the reason for not performing systematic, extensive hemodynamic measurements, and it is another point in which our practice is in accordance with the Chinese experience. Whatever the technique used, one should not forget that the experience of the team is also a strong determinant of the complication rate of percutaneous balloon mitral valvuloplasty.^R2 Safety is a major concern with a new technique, especially when its purpose is to replace treatments that carry a very low risk, as was the case with closed-heart commissurotomy.

In addition, large series from different countries provide complementary information. The Chinese experience reports good immediate and late results with percutaneous balloon mitral valvuloplasty in a population composed of mostly young patients (mean age, 38 years). Such findings are of interest in countries in which the incidence of rheumatic fever remains relatively high.^R3 The problem is different in the United States and Europe, where patients with mitral stenosis are older and more frequently have advanced heart disease. In such cases, the most relevant findings are not the global rates of good immediate and late outcome, which take into account a heterogeneous population, but the identification of the predictive factors of immediate and late results, which represent an important aid in patient selection.^{R1 R4 R5}

Finally, balloon valvuloplasty ably illustrates the interest in the evaluation of new techniques by diverse large reports. We now have evidence from large international series that percutaneous balloon mitral valvuloplasty is a well-established technique for the treatment of mitral stenosis in a wide range of patients.

	References

Top Introduction References Introduction  References

 

1. Iung B, Garbarz E, Michaud P, et al. Late results of percutaneous mitral commissurotomy in a series of 1024 patients: analysis of late clinical deterioration: frequency, anatomical findings, and predictive factors. Circulation. 1999;99:3272–3278.
   
2. The NHLBI balloon valvuloplasty registry participants. Complications and mortality of percutaneous balloon mitral commissurotomy. Circulation. 1992;85:2014–2024.[Abstract/Free Full Text]
   
3. Percutaneous balloon mitral valvuloplasty by the Inoue technique: a multicenter study of 4832 patients in China. Am Heart J. 1995;129:1197–1203.[Medline] [Order article via Infotrieve]
   
4. The NHLBI balloon valvuloplasty registry participants. Multicenter experience with balloon mitral commissurotomy. Circulation. 1992;85:448–461.[Abstract/Free Full Text]
   
5. Iung B, Cormier B, Ducimetière P, et al. Immediate results of percutaneous mitral commissurotomy: a predictive model on a series of 1514 patients. Circulation. 1996;94:2124–2130.[Abstract/Free Full Text]
   

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 Google Scholar Google Scholar Articles by Cheng, T. O. Articles by Vahanian, A. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O. Articles by Vahanian, A. Related Collections Valvular heart disease Catheter-based coronary and valvular interventions: other Echocardiography CV surgery: valvular disease