Percutaneous transarterial balloon mitral valvuloplasty: 30 months experience

Between February, 1985, and August, 1987, 76 patients with mitral stenosis underwent percutaneous transarterial mitral balloon valvuloplasty (MVP). There were 58 females and 18 males aged from 15 to 69 years (mean 39 +/- 11). In 31 patients the mitral valve was pliable (40%) and in 45 patients (60%) the valve was nonpliable. Calcified mitral stenosis was found in 24 patients (31%). Transseptal catheterization was used to place one or two 0.035" (350 cm long) exchange wires into the ascending aorta in order to be snared, retrieved and exteriorized, each one through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for mitral dilation. Single (25 mm in diameter, trefoil 3 x 12 mm, bifoil 2 x 19 mm) and double (18 and 15 mm, 18 and 18 mm, 18 and 20 mm) balloons were used in 24 and 52 patients respectively. Transarterial mitral valvuloplasty produced immediate improvement of mitral valve area (MVA = 1.1 +/- 0.3 to 2.4 +/- 0.4 cm2, p less than 0.001), mitral valve gradient (19 +/- 4 to 8 +/- 6 mmHg, p less than 0.001), echocardiographic left atrial diameter (LAD = 58 +/- 6 to 54 +/- 5 mm, p greater than 0.05) and echo-MVA (0.9 +/- 0.4 to 2.1 +/- 0.7, p less than 0.001). In three patients no MVA enlargement was achieved. A significant mitral regurgitation was produced in two patients. A stroke occurred in three patients (3.9%), one of these patients subsequently died (1.3%), one recovered and one remained hemiplegic. No atrial septal defect was found after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)