Percutaneous Transvenous Mitral Commissurotomy for Post-Surgical Mitral Restenosis: Acute Outcome and Analysis of Factors Influencing Results.
The present study examined the utility of percutaneous transvenous mitral commissurotomy (PTMC) for post-surgical mitral restenosis (Group I, n = 71 patients), and the factors influencing the outcome of the procedure. The results of PTMC were also compared with a group of patients (Group II, n = 70 patients), who underwent PTMC for de novo mitral stenosis. Both the groups were matched for age, pre-procedure mitral valve area and echocardiographic score. PTMC was successful in 60 patients (85%) in group I and in 68 patients (97%) in group II (p < 0.05). However, the final mitral valve area achieved was similar between the two groups (1.8 +/- 0.3 vs. 1.9 +/- 0.2 sq.cm, p = NS). Patients in group I had significantly greater mitral valve calcification (0.6 +/- 0.8 vs. 0.3 +/- 0.6, p < 0.05). Multiple regression analysis of results in patients with post-surgical restenosis revealed that only basal mean pulmonary artery pressure and basal cardiac index correlated significantly with increase in valve area. Mitral valve leaflet mobility, thickness and subvalvular deformity did not correlate significantly with the increase in mitral valve area. CONCLUSION: PTMC is a safe procedure for post-surgical mitral restenosis with negligible complication, with a higher success and significantly lower complication rate than that reported for repeat surgical commissurotomy. Although patients with surgical restenosis had a greater degree of calcification of mitral valve leaflets; only basal mean pulmonary artery pressure and cardiac index significantly influenced the increase in mitral valve area. Increased fibrosis of mitral leaflet following surgery probably adversely influences the results of PTMC for post-surgical mitral restenosis.
Chandrasekar
B
Chief Cardiologist, Railway Hospital, Perambur, Chennai-600, 023, India.
Abraham
KA
Rajagopal
S
Somanath
HS
Sudarsana
G