title: Results of percutaneous double-balloon mitral commissurotomy in one medical center in Tunisia.
abstract: Percutaneous balloon mitral commissurotomy was attempted in Tunisia, where rheumatic fever is still endemic, in 463 consecutive patients with severe rheumatic mitral valve stenosis. Their mean age +/- SD was 33 +/- 12 years (range 8 to 68), 324 patients (70%) were women, and 327 (71%) were in sinus rhythm. Valvotomy was technically successful in 454 patients (98%). The mean mitral valve gradient decreased from 20 +/- 7 to 6 +/- 4 mm Hg, mean left atrial pressure decreased from 27 +/- 8 to 15 +/- 6 mm Hg, cardiac index increased from 3.0 +/- 0.7 to 3.6 +/- 0.8 L/min/m2, and Gorlin mitral valve area, from 0.97 +/- 0.19 to 2.2 +/- 0.4 cm2 (all p < 0.001). Two-dimensional echocardiographic mitral valve area increased from 1.03 +/- 0.18 to 2.15 +/- 0.36 cm2 (p < 0.00001). A final valve area of > or = 1.5 cm2 was achieved in 98% of patients. Multivariate analysis identified a pre-mitral valve area < 0.8 cm2 and an echocardiographic score (echo score) > or = 12 as the strongest predictors of residual stenosis (final mitral valve area < 1.5 cm2). Major procedural complications included mortality (0.4%), tamponade (0.7%), thromboembolism (2.0%), severe mitral regurgitation (4.6%), significant (pulmonary to systemic flow ratio > or = 1.5) interatrial shunt (4.8%). Four hundred thirty patients were followed up between 6 and 82 months (mean 37 +/- 22): 95% were in functional class I to II without reintervention, and 7 patients died (1.6%); restenosis (echocardiographic mitral valve area < 1.5 cm2) occurred in 10.4% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Ben Farhat
authors.forename: F
authors.initials: F
authors.lastname: Betbout
authors.forename: H
authors.initials: H
authors.lastname: Gamra
authors.forename: F
authors.initials: F
authors.lastname: Maatouk
authors.forename: M
authors.initials: M
authors.lastname: Ayari
authors.forename: A
authors.initials: A
authors.lastname: Cherif
authors.forename: M
authors.initials: M
authors.lastname: Jarrar
authors.forename: H
authors.initials: H
authors.lastname: Boussadia
authors.forename: S
authors.initials: S
authors.lastname: Hammami
authors.forename: I
authors.initials: I
authors.lastname: Chahbani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D002404:Catheterization; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology / Q000628:therapy; D012214:Rheumatic Heart Disease / Q000150:complications / Q000503:physiopathology; D016896:Treatment Outcome; D014416:Tunisia