Percutaneous Catheter Commissurotomy in Rheumatic Mitral Stenosis

Abstract

We attempted percutaneous transcatheter-balloon mitral commissurotomy in eight children and young adults (9 to 23 years of age) with rheumatic mitral stenosis. The atrial septum was traversed by needle puncture, and an 8-mm angioplasty balloon was advanced over a guide wire. The atrial septal perforation was then dilated to allow passage of the valvuloplasty balloon catheter (18 to 25 mm) across the mitral annulus. Inflation of the transmitral balloon decreased the end-diastolic transmitral gradient temporarily in all patients (from 21.2 +/- 4.0 mm Hg [mean +/- S.D.] to 10.1 +/- 5.5 mm Hg; P less than 0.001). The immediate decrease in the gradient was associated with increases in cardiac output (from 3.8 +/- 1.0 to 4.9 +/- 1.3 liters per minute per square meter of body-surface area; P less than 0.01) and in the calculated mitral-valve-area index (from 0.73 +/- 0.29 to 1.34 +/- 0.32 cm2 per square meter; P less than 0.001). Murmur intensity diminished immediately after commissurotomy in all patients. The greatest reduction in pressure gradient (76 to 95 per cent) occurred when the largest balloon (inflated diameter, 25 mm) was used in the smallest patients (0.9 to 1.2 m2). The balloon commissurotomy produced minimal mitral regurgitation in only one child. Follow-up catheterization (at two to eight weeks) demonstrated persistence of hemodynamic improvement with evidence of partial restenosis in one patient. These early results indicate that balloon mitral commissurotomy can be a safe and effective treatment for children and young adults with rheumatic mitral stenosis.

Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome.

“…These findings are consistent both with our experimental animal work6 and with some published clinical experience with newborn critical aortic stenosisl6 reporting damage to the-left ventricular outflow tract and aortic valve with oversized balloons. Surprisingly, the BAR in the range of this study did not influence PRG in contrast to our results from many other models and congenital lesions,12 13,[20][21][22][23][24][25][26] in which progressively increasing balloon sizes were also used. Relief of obstruction was mostly associated with recognizable commissural division.…”

Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease

“…Although rheumatic mitral valve stenosis is commonly due to the development of thickened mitral leaflets and fused commissures, congenital mitral stenosis encompasses a broad spectrum of anatomic variants, including the "typical" variant with thickened leaflets, shortened chordae, and decreased interchordal spaces; 133 and others soon reported their experience. 134 -137 This procedure was extended to patients with congenital mitral valve stenosis.…”

Left-to-right atrial shunting after percutaneous mitral valvuloplasty. Incidence and long-term hemodynamic follow-up.

“…Immediately after PMV, 19 (58%) had left-to-right atrial shunts detected by dilution curves, and 10 of these 19 had shunts also detected by oximetry; mean Qp/Qs was 1 Hemodynamic variables in the 14 patients with a long-term shunt decrease were compared with those in the eight patients with no change or a shunt increase (Table 4). Mitral valve area decreased and mitral gradient increased during the 6 months after PMV in patients with no change or a shunt increase but not in patients with a shunt decrease.…”