Rheumatic fever recurrence: a possible cause of restenosis after percutaneous mitral valvuloplasty.
BACKGROUND
We evaluated the occurrence of a rapid process of restenosis after percutaneous mitral valvuloplasty (PMV), initiated by the recurrence of acute rheumatic fever. Restenosis after PMV has been mainly related to a high echocardiographic score (> or = 8) indicating a severely compromised mitral valve apparatus.


METHODS
From 1986 to 1996, 120 patients underwent PMV by the transseptal approach at our Institution. The mean follow-up time was 58 +/- 32 months (range 3 months to 9 years).


RESULTS
Restenosis occurred in 10 patients (8.3%): in 4 restenosis was found within a relatively short period of time (1 to 3 months) following a documented recurrence of acute rheumatic fever; in the other 6 patients there was a gradual loss of the initial gain in the mitral valve area.


CONCLUSIONS
These data suggest two potential mechanisms of restenosis: 1) a more common slow process, due to turbulent flow-trauma on the mitral valve; 2) a rapid process that relates to valvulitis consequent to a recurrence of acute rheumatic fever. In consideration of the second possibility, after PMV prophylactic treatment may be warranted at least in those patients who are at high risk of streptococcal infection.
Nigri
A
A
Institute of Cardiac Surgery, La Sapienza University of Rome, Italy. antonio.nigri@uniroma1.it
Alessandri
N
N
Martuscelli
E
E
Pizzuto
F
F
Sardella
G
G
Berni
A
A
Romeo
F
F
Papalia
U
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000517:prevention & control