[Indications for percutaneous transvenous mitral commissurotomy: evaluation according to the Sellors classification]

Fifty-eight consecutive patients underwent percutaneous transvenous mitral commissurotomy (PTMC) for mitral stenosis from August 1987 to June 1990. Patients were divided by echocardiographic characteristics of the mitral valve according to the Sellors classification into three groups: group 1 (mobile cusps, 20 patients), group 2 (thickened cusps, 34 patients), group 3 (rigid cusps, 4 patients). Immediately after PTMC, the mitral valve area increased significantly from 1.41 +/- 0.37 to 2.07 +/- 0.38 cm2 (p < 0.01) in group 1 and from 1.09 +/- 0.21 to 1.64 +/- 0.25 cm2 (p < 0.01) in group 2. The mitral valve area did not increase significantly in group 3 (from 0.82 +/- 0.27 to 1.10 +/- 0.22 cm2). Mitral regurgitation developed or increased in severity in four patients (100%) in group 3 (p < 0.01 vs group 1, 20% and group 2, 21%). The symptomatic improvement was 0% for group 3 (p < 0.01 vs group 1, 90% and group 2, 91%). At follow-up period (mean 24.6 months), symptomatic improvement was maintained in 44 patients (76%) of the total patient population. The mitral valve area was maintained well in group 1 and group 2, but three patients in group 2 showed recurrence of symptoms due to valvular restenosis. PTMC is an effective nonsurgical treatment for patients with mobile or with thickened cusps. Surgical method is preferable for patients with rigid cusps.