[Mitral insufficiency after mitral balloon-catheter valvuloplasty: its incidence, predictive factors and prognosis]

From October 1991 to October 1993, a total of 205 patients with rheumatic mitral stenosis (178 female, 27 male, mean age 38 years, range 17-72) underwent percutaneous transvenous mitral commissurotomy (PTMC), 138 with the Inoue balloon and 67 with double balloon-catheter techniques. Mitral regurgitation (MR) was detected in 10% of the cases prior to the procedure, and 37% after PTMC (p < 0.05), grade I in 45 patients (22%), grade II in 24 (12%), grade III in 4 (2%), and grade IV in 3 (1.5%) cases (p = 0.003, 0.002, N.S. and N.S., respectively. In 40% of the total group (83/205) there was no new or worsening MR; in 26.8% of the cases (55/205) new MR appeared (p = 0.004); in 23% (47/205) MR increased one grade (p = 0.002) and in 9.7% (20/205) two or more grades. The comparative incidence of MR was 40.5% (56/138) with the Inoue balloon, and 16.4% (11/67) with the double balloon technique (p = 0.03); the severity of MR was grade I in 27% vs 9% (p = 0.001), grade II in 9.4% vs 6% (p = 0.05), grade III in 2.1% vs 1.5% (N.S.), and grade IV in 2.1% vs 0% (N.S.). Only the presence of commissural calcification and echo-score > 8 points were found as independent predictors of severe MR. In conclusion, mild and moderate MR occur frequently after PTMC, with significantly greater incidence using the Inoue technique. Severe MR following PTMC is much less frequent, and the comparative incidence is somewhat greater with the Inoue balloon, though the difference is not significant.