Immediate and midterm outcome of balloon mitral valvotomy in children and adolescents

The midterm and long term results of balloon mitral valvotomy (BMV) have not been well characterized, particularly in those below the age of 20 years.

The present study evaluated the hemodynamic benefits, safety and efficacy, as well as the midterm follow-up results, of Inoue BMV in children and adolescents less than 20 years of age who have severe mitral stenosis.

Sixty-one patients younger than 20 years of age underwent BMV between December 1989 and May 1998.

All patients underwent BMV using the Inoue balloon for symptomatic severe mitral stenosis with a mitral valve area less than 1.2 cm2. Cardiac hemodynamics were acquired before and immediately after BMV. In addition, Doppler echocardiography measurements were obtained during follow-up.

The procedure was successful in 59 patients (96.7%). There were no deaths during the procedure or during follow-up. The mean Boston Mitral Echo score was 7.4 1.4. Mitral valve area on cardiac catheterization increased from 0.8 0.3 to 1.9 0.6 cm2 (P<0.001), and the mean mitral valve gradient decreased from 16.9 5 to 5.8 2.8 mmHg (P<0.001). Severe mitral regurgitation developed in one patient (1.6%) and cardiac tamponade developed in two. At a mean follow-up of 36.9 27 months (range 12 to 84 months), mitral valve area by Doppler echocardiography remained at 1.7 0.4 cm2 and the mean mitral valve gradient by Doppler echocardiography was 6 2 mmHg.

BMV is safe and effective in children and adolescent patients with rheumatic mitral stenosis and provides a similar hemodynamic benefit with that reported in adults. The benefits were sustained during a mean follow-up period of 36 months.