title: Percutaneous transvenous mitral commissurotomy using Inoue catheter in juvenile rheumatic mitral stenosis.
abstract: Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue balloon was performed in 270 patients with rheumatic mitral stenosis. Of these 81 (27%), 48 males and 33 females, had juvenile mitral stenosis (age < 20 years, range 9-20 years mean 14 +/- 5). All patients were symptomatic (New York Heart Association [NYHA] class III in 61 patients and class IV in 20 patients). Following PTMC, the mitral valve area (MVA) increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 cm2 (P < 0.001) and the cardiac index increased from 2.4 +/- 0.8 to 3.0 +/- 0.8 L/min/m2 (P < 0.001). Mean transmitral gradients decreased from 24 +/- 8 to 4 +/- 3 mm Hg (P < 0.001). Three (4%) patients had an increase in mitral regurgitation by 1 grade (grade 2/4); however, none required surgery. Significant left to right atrial shunt (Qp/Qs > 1.3: 1) on oximetry was detected in 8 (10%) patients. Overall results were compared to those with adult subgroup of patients with rheumatic mitral stenosis (n = 189, 100 females and 89 males), who underwent PTMC simultaneously. Their age ranged from 21 to 44 years (mean 32 +/- 11 years). The percentage increase in MVA was higher in juvenile as compared to adult patients (172 +/- 61 vs. 154 +/- 69, respectively, P < 0.01). A larger final MVA was achieved in the juvenile group (2.2 +/- 0.5 vs. 1.9 +/- 0.3 cm2, P < 0.05). However, the incidence of increase in mitral regurgitation by 1 grade was similar in two groups (6% vs. 4%, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
authors.forename: V K
authors.initials: VK
authors.lastname: Bahl
authors.forename: S
authors.initials: S
authors.lastname: Chandra
authors.forename: S S
authors.initials: SS
authors.lastname: Kothari
authors.forename: K K
authors.initials: KK
authors.lastname: Talwar
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: U
authors.initials: U
authors.lastname: Kaul
authors.forename: M
authors.initials: M
authors.lastname: Rajani
authors.forename: H S
authors.initials: HS
authors.lastname: Wasir
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002648:Child; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000473:pathology; D008946:Mitral Valve Stenosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000628:therapy