Immediate and mid-term results of percutaneous mitral commissurotomy

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Abstract
The results of percutaneous mitral commiurotomy (PMC) were assessed in a series of 600 patients (pts) with mitral stenosis. Their mean age was 43±15 years (13–86). One hundred and eight had had a previous surgical commissurotomy; 464 were in NYHA class III or IV; atrial fibrillotion was present in 188. One hundred and fifty-nine had valvular calcification and angiography disclosed a mild regurgitation (MR) (1/4) in 255. Technical failure occured in 19pts. In the remainder, PMC improved valve function: valve area (VA) increased from 1·1±0·3 cm2 to 2·2±0.5cm2 (P < 0·0001) as assessed by haemodynamics, and from 1±0·2 to 2±0·4 cm2 (P < 0·0001) as assessed by two-dimensional echocardiography. Complications were as follows: death (0·5%), haemopencardium (0·8%), severe MR (3·8%), embolkm (3·3%), atrial shunt (14%). Secondary surgery for complications following PMC was necessary in 4·8% of cases. There were poor results (VA < 1·5cm and/or MR > 2/4) in 13% their predictors being valve anatomy (P < 0·01), initial valve area (P < 0·01) and previous surgical commksurotomy (P < 0·05). Among the 437 pts resident in France, 98% were followed-up 15±11 months after PMC (range 1–48). After 42 months, the actuarial rates of survival, freedom from need for reoperation and good functional results were respectively: 87±6%, 81±3% and 72±6%. The quality of the initial results (P<0.001) and valve anatomy (P<0.·1) were predictors of the long-term outcome. In conclusion (1) PMC is an effective treatment in a wide range of patients with mitral stenosis; (2) complications are infrequent but may need secondary surgery (3) valve anatomy is a predictor for both immediate and mid-term results.

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