title: Comparison of early results of percutaneous metallic mitral commissurotome with Inoue balloon technique in patients with high mitral echocardiographic scores.
abstract: We compared the safety, efficacy, and cost of the newly introduced percutaneous metallic commissurotome (PMC) with the results of Inoue balloon mitral valvuloplasty (BMV) in 80 patients with mitral stenosis (MS). The mean increase in mitral valve area (MVA) was 0.95 +/- 0.19 to 1.7 +/- 0.35 cm(2) for PMC and 0.97 +/- 0.15 to 1.81 +/- 0.36 cm(2) for BMV (P = NS). The Wilkins echocardiographic scores before dilatation did not correlate with any difference in MVA after dilatation. Bilateral commissural splitting was significantly more common with PMC than with BMV (30/39 patients, 76.9%, vs. 21/40 patients, 52.5%; P = 0.02). Postprocedural severe mitral regurgitation occurred in 1/39 (2.6%) in the PMC group and in 4/41 (9.8%) in the BMV group. Because the PMC device is resterilizable, we estimated the cost to be one-fourth the cost of BMV with the Inoue balloon. The estimated device cost ratio of PMC to BMV for each patient was 1 to 4.25. The early results of PMC on the MVA are comparable to BMV. However, PMC had better results not only in patients with high echocardiographic scores, but the PMC device splits commissural calcification better than BMV.
authors.affiliation: Department of Cardiology, Cairo University Hospitals, Cairo, Egypt. adel@heartj.com
authors.forename: Adel M
authors.initials: AM
authors.lastname: Zaki
authors.forename: Hussien H
authors.initials: HH
authors.lastname: Kasem
authors.forename: Sameh
authors.initials: S
authors.lastname: Bakhoum
authors.forename: Magdy
authors.initials: M
authors.lastname: Mokhtar
authors.forename: Wael
authors.initials: W
authors.lastname: El Nagar
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: White
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Guindy
mesh_terms: D000328:Adult; D002404:Catheterization / Q000191:economics; D003365:Costs and Cost Analysis; D004452:Echocardiography / Q000191:economics; D004534:Egypt / Q000453:epidemiology; D004869:Equipment Safety / Q000191:economics; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D006350:Heart Valve Prosthesis / Q000191:economics; D006801:Humans; D015994:Incidence; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome