Indications, complications, and short-term clinical outcome of percutaneous transvenous mitral commissurotomy

M. Nobuyoshi, N. Hamasaki, T. Kimura, H. Nosaka, H. Yokoi, H. Yasumoto, H. Horiuchi, H. Nakashima, T. Shindo, T. Mori, A. T. Miyamoto, K. Inoue

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185 Citations (Scopus)

Abstract

Percutaneous transvenous mitral commissurotomy was performed in 106 consecutive patients. Significant symptomatic improvement was achieved in 97 patients (92%). Mean left atrial pressure decreased (from 18 ± 8 to 11 ± 8 mm Hg, p < 0.00001), mean atrial diastolic pressure gradient decreased (from 12 ± 7 to 7 ± 6 mm Hg, p < 0.00001), and mitral valve area increased (from 1.40 ± 0.40 to 2.00 ± 0.50 cm2, p < 0.00001). Based on echocardiographic characteristics of the mitral apparatus, patients were grouped retrospectively in three categories: pliable (group 1, n = 37), semipliable (group 2, n = 59), and rigid (group 3, n = 10). Clinical success was achieved in 36 patients of group 1 (97%) and in 55 patients of group 2 (93%). Only six patients in group 3 (60%) improved symptomatically (p < 0.001 vs group 1, p < 0.001 vs group 2). The severity of mitral regurgitation increased in five patients of group 1 (14%), in 12 of group 2 (20%), and in three of group 3 (33%). Six patients had recurrent symptoms at 9 months after commissurotomy. Recurrence of symptoms was significantly more frequent in group 3 compared with the other two groups (group 1, 3%; group 2, 4%; and group 3, 50%, p < 0.0001 vs groups 1 and 2). Multiple regression analysis identified the previously mentioned echocardiographic characteristics of the mitral apparatus as the significant predictor for clinical outcome. Thus, percutaneous transvenous mitral commissurotomy can be considered a safe and effective treatment for patients with pliable valves. Patients with semipliable or with rigid valves should be selected for operation very carefully.

Original languageEnglish
Pages (from-to)782-792
Number of pages11
JournalCirculation
Volume80
Issue number4
DOIs
Publication statusPublished - 1989
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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