[The treatment of severe mitral stenosis by percutaneous transvenous commissurotomy]

In 110 adult selected patients, 87.1% female (average age 38.2 years, range 16-72) with symptomatic, severe mitral stenosis eligible for surgery, we performed balloon catheter transvenous mitral commissurotomy (BCTMC) as alternative treatment. Inoue's catheter was utilized in 80 cases (72.7%), and the double-balloon technique in 30 (27.3%). The procedure was successful in 102 patients (92.7%, 2nd attempt in 5 cases), with optimal results in 96 (87.3%); and it was unsuccessful in one patient for a technical difficulty. Complications occurred in 3 cases due to perforation of a cardiac chamber (2.7%); and 4/106 patients developed severe mitral insufficiency (3.8%). The mitral valve area increased from 1.09 +/- 0.27 to 2.6 +/- 0.87 cm2 (p < 0.0001); the diastolic mitral gradient decreased from 18.9 +/- 5.9 to 3.6 +/- 2.8 mmHg (p < 0.0001); similar reduction was obtained in mean left atrial pressure from 26.2 +/- 6.5 to 12.5 +/- 4.2 mmHg (p < 0.0001), and mean pulmonary artery pressure from 38 +/- 17 to 26.2 +/- 10.4 mmHg (p < 0.005). New mitral insufficiency appeared or increased in more of one grade in 12/106 patients (11.3%), and it was not detectable in 86/106 patients. During long-term follow-up (average 10.4 months, range 5 to 24), all patients (100 cases) improved their functional class (83.1% asymptomatic), and maintained their 2D echocardiographic mitral valve area. In conclusion BCMTC is the treatment of choice for selected cases of acquired symptomatic mitral stenosis, with immediate and long term results comparable to surgical commissurotomy.