title: Percutaneous Inoue-Balloon Mitral Commissurotomy in Patients with Coexisting Moderate Mitral Regurgitation, and Severe Subvalvular Disease and/or Mitral Calcification.
abstract: The present study examined the safety and immediate and late outcome of 12 patients with coexisting moderate (angiographic grade 2+) mitral regurgitation and significant subvalvular disease and/or calcified mitral valves (group 1) after percutaneous balloon mitral commissurotomy (BMC) and compared the results with 64 patients without these adverse valve features (group 2). BMC produced a significantly smaller echocardiographically determined mitral valve area improvement in group 1 compared with group 2 (from 0.7 +/- 0.2 cm2 to 1.3 +/- 0.3 cm2 vs. 0.8 +/- 0.2 cm2 to 1.7 +/- 0.4 cm2, respectively, p < 0.05). Similarly, compared with group 2, less patients in group 1 obtained an optimal valvuloplasty outcome defined as a ³ 50% increase in mitral valve area or a final valve area of ³ 1.5 cm2 without final ³ 3 grade angiographic mitral regurgitation (75% vs. 95%, p < 0.05). There was, however, no severe (³ angiographic grade 3+) mitral regurgitation in group 1 compared with 1 in group 2 (p = NS). At a mean follow-up of 19 +/- 14 months, there were no deaths or strokes. Restenosis was noted in 4 patients; 3 in group 1, and 1 in group 2. We conclude that BMC is safe and effective in patients with pre-existing moderate mitral regurgitation and severe subvalvular disease and/or significant mitral calcification with minimal risk of creating severe mitral regurgitation. The valve area improvement was, however, substantially smaller and the restenosis rate higher than those without moderate mitral regurgitation and favorable valve anatomy.
authors.affiliation: Consultant Cardiologist, Singapore Heart Centre, Mistri Wing, 3rd Hospital Avenue, Singapore, 0316.
authors.initials: KW
authors.lastname: Lau
authors.initials: ZP
authors.lastname: Ding
authors.initials: TH
authors.lastname: Koh
authors.initials: A
authors.lastname: Johan