[Percutaneous transvenous mitral valvuloplasty: short-term effects and complications]

Percutaneous transvenous mitral valvuloplasty (PTMV) using the Inoue balloon was performed in 18 patients with symptomatic mitral stenosis. They were seven men and 11 women, ranging in age from 38 to 77 years (mean 59 +/- 10 years). Among them, 13 were categorized as NYHA class II; four as class III; and one as class IV. As a result, the symptoms of 14 patients markedly improved. Survey by means of right and left heart catheterization and echocardiography before and after PTMV demonstrated significant improvement in test values; (1) a decrease in the mean mitral gradient from 8.5 +/- 3.3 to 4.8 +/- 2.0 mmHg (p less than 0.01), (2) an increase in the mean diastolic descent rate of the mitral valve from 17.6 +/- 8.3 to 25.1 +/- 8.1 mm/sec. (p less than 0.01), and (3) an increase in the mean mitral valve area from 1.3 +/- 0.5 to 1.7 +/- 0.5 cm2 (p less than 0.01). Bicycle ergometer stress test performed on the 13 patients before and after PTMV revealed a significant decrease in the mean pulmonary arterial pressure from 24 +/- 5 to 18 +/- 5 mmHg (p less than 0.01) at rest, and from 49 +/- 9 to 42 +/- 7 mmHg (p less than 0.05) after exercise. The degree of mitral regurgitation increased after PTMV in six patients, in three of whom it was severe. The severity was evidenced by a significant increase in the ratio of the mean balloon diameter to body surface area as compared with the data of the other 15 patients (20.6 +/- 2.2 to 18.0 +/- 1.4 mm/m2; p less than 0.05), the presence of a localized sclerosis of the mitral valve as demonstrated by two-dimensional echocardiography, and prolapse of the mitral valve as shown by a left atriogram. These early results indicated that PTMV using the Inoue balloon is an effective treatment for symptomatic patients with mitral stenosis unless severe mitral regurgitation develops. This complication may be partially due to the selection of an inappropriate balloon diameter, and due to co-existing myxomatous degeneration and localized sclerotic changes of the mitral valve.