title: Hemodynamic and clinical efficacies of catheter balloon percutaneous transvenous mitral commissurotomy: experience of 100 patients with rheumatic mitral stenosis.
abstract: From January 1987 to December 1988, 100 patients with symptomatic severe rheumatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PTMC). The patients included 32 males and 68 females, aged 19-71 years (mean of 41). Mild mitral regurgitation (grade 1 or 2) was present in 23 patients and a history of thromboembolism in 12. One patient had had mitral restenosis after surgical open mitral commissurotomy 9 years earlier. The mitral valve was successfully dilated in 97 patients. PTMC resulted in immediate improvements in hemodynamic measurements. The left atrial pressure decreased from 24.5 +/- 5.3 to 14.8 +/- 5.2 mmHg (p less than 0.001), the mean mitral transvalvular gradient from 13.8 +/- 4.8 to 5.0 +/- 2.8 mmHg (p less than 0.001), and the mean pulmonary artery pressure from 38.8 +/- 12.0 to 30.6 +/- 10.3 mmHg (p less than 0.001). The mitral valve area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). The cardiac output increased from 4.5 +/- 1.2 to 4.84 +/- 1.2 L/min (p less than 0.05). The right atrial pressure did not change significantly after PTMC (6.5 +/- 3.8 vs 6.4 +/- 4.0 mmHg). The mitral valve area measured by 2-D echocardiograms increased from 1.04 +/- 0.48 to 1.88 +/- 0.66 cm2 after PTMC (p less than 0.001). All 97 patients were followed for 6-24 months (median of 13) after the PTMC. After an initial recovery period of 1-2 weeks, all patients reported improvements in symptoms and in New York Heart Association (NYHA) functional class by at least one class. A comparison between treadmill exercise test durations before, and 3 months after PTMC, showed an increase from 9.1 +/- 4.3 to 15.4 +/- 3.8 minutes (n = 60; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, Chang Gung Memorial Hospital, Taiwan, R.O.C.
authors.forename: J S
authors.initials: JS
authors.lastname: Hung
authors.forename: M
authors.initials: M
authors.lastname: Fu
authors.forename: S J
authors.initials: SJ
authors.lastname: Yeh
authors.forename: F C
authors.initials: FC
authors.lastname: Lin
authors.forename: W J
authors.initials: WJ
authors.lastname: Cherng
authors.forename: K H
authors.initials: KH
authors.lastname: Yeh
authors.forename: Y C
authors.initials: YC
authors.lastname: Wu
authors.forename: D
authors.initials: D
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging; D008946:Mitral Valve Stenosis / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D012214:Rheumatic Heart Disease / Q000503:physiopathology / Q000628:therapy*