Percutaneous transvenous mitral commissurotomy for restenosis after surgical mitral valvotomy

Abstract

Summary:Percutaneous transvenous mitral cornmissurotomy (PTMC) was performed in 350 patients. Of these patients, 5 I ( 15%) (30 women and 2 1 men, aged 32 k 1 1 years) had restenosis 1 1 & 4 years following surgical valvotomy. Forty (79%) patients were in New York Heart Association (NYHA) class III and 1 1 (21 %) were in class IV. PTMC resulted in an increase in mitral valve area from 0.82 k 0.3 to 1.9 k 0.2 cm2 (p <0.001), an increase in cardiac index from 1.9 + 0.4 to 2.8 f 0.5 l/min/m2 (p < 0.001), and a decrease in mean transmitral gradients from 29+4 to6+4mnlHg(p<0.001).Theresultsdid notdifferfrom those observed in 299 patients without prior surgical valvotomy. On univariate analysis, the subvalvular fibrosis, assessed angiographically, and the duration from prior surgery were not found to influence the overall outcome. At 24 weeks, 46 of 48 (96%) patients in whom clinical follow-up was available, were found to be in NYHA class I and 2 (4%) patients were in class 11. Thus, PTMC is a safe and effective procedure for patients with mitral restenosis following surgical valvotomy.