Randomized comparison between Inoue balloon and metallic commissurotome in the treatment of rheumatic mitral stenosis: Immediate results and 6‐month and 3‐year follow‐up

Abstract

The metallic commissurotome (MC) technique is a cheaper alternative to the Inoue balloon (IB) technique for percutaneous mitral valvuloplasty (PMV). There are no randomized trials comparing these techniques with longer follow-up of the patients. The objective of this study was to compare the immediate results and short- and medium-term follow-up of PMV using either the IB or the MC technique. Fifty patients with rheumatic mitral stenosis were randomly assigned to PMV using the IB (n = 27) or the MC (n = 23) technique. There were no significant differences between the groups regarding baseline clinical, echocardiographic, and hemodynamic data. Clinical and echocardiographic follow-up were done 6 months and 3 years after the procedure. The success rate was 100% in the IB group and 91.3% in the MC group (P = 0.15); two patients in the latter group developed mitral regurgitation grade 3/4, requiring elective surgery. The mean final mitral valve area was bigger in the MC group (2.17 +/- 0.13 vs. 2.00 +/- 0.36 cm2; P = 0.04), but after 6-month and 3-year follow-up, this difference was no longer significant (2.06 +/- 0.27 vs. 1.98 +/- 0.38 cm2, P = 0.22, and 1.86 +/- 0.32 vs. 1.87 +/- 0.34 cm2, P = 0.89, respectively). This finding suggests valve stretching as an important mechanism of valve dilation with the MC. Three patients in the MC group and two patients in the IB group (P = 0.65) developed mitral valve restenosis; one of them underwent repeat PMV and the other four, all asymptomatic, were clinically followed. PMV performed either with the IB or the MC technique is effective and provides excellent short- and medium-term outcomes regardless of the technique employed.

Percutaneous transmitral commissurotomy in juvenile mitral stenosis—comparison of long term results of Inoue balloon technique and metallic commissurotomy

“…Regarding MR, one patient in each group had to go for emergency MVR because of AML tear, in our series. Other authors also report a similar incidence of MR requiring MVR [18, 19, 29].…”

“…In a nonrandomized comparison, Mittal et al [30], found that PMMC group ( n = 127) had a higher gain in valve area compared with Inoue ( n = 350) technique, (126% vs. 111.4% ( P < 0.05). Also in the series by Guerios et al [29], PMMC produced a larger postvalvuloplasty valve area (1.98 vs. 2.17 cm 2 , P = 0.04), immediately after the procedure.…”

“…In this study, both techniques had similar procedural success. In a recent randomized study of 50 patients, Guerios et al [29] found similar success with both procedures. Also, Bhat et al [22], in a randomized comparison, found similar success rates with both techniques.…”

“…A meta‐analysis of international experience with IBMC in adults [4] showed that the procedure yielded a postvalvotomy mitral valve area of 1.84 cm 2 . The postprocedure mitral valve area of 348 patients with JMS who underwent IBMC from different series [8–31] was 1.9 cm 2 (Table V). This is very well comparable to the data following PMMC in our group of patients, where we obtained a valve area of 1.95 cm 2 .…”

Evolução da onda P do eletrocardiograma após valvoplastia mitral em pacientes portadores de sobrecarga atrial esquerda

“…A low rate of complication with significant clinical and hemodynamic improvement is expected in the short and long term 4 . In successful procedures, the mitral valve area usually doubles, and the transvalvular gradient decreases by 50% to 60% immediately after the procedure 3,5 .…”