title: Effectiveness of percutaneous mechanical mitral commissurotomy using the metallic commissurotome in patients with restenosis after balloon or previous surgical commissurotomy.
abstract: Balloon mitral valvuloplasty has been reported to give equal or less positive results after previous commissurotomy than after a first procedure. Percutaneous mechanical mitral commissurotomy (PMMC) is a new technique that has not yet been evaluated in this subset of patients. Of 1,175 PMMC procedures (1,175 patients), 173 patients (14.7%) had previous commissurotomy; patients were older (40 vs 35 years of age, p <0.0001) and more often in atrial fibrillation (34% vs 21%, p = 0.0016) than were patients who had not undergone previous commissurotomy. The baseline transmitral gradient was lower (17 +/- 8 vs 19 +/- 8 mm Hg, p <0.002) and the echocardiographic Wilkins score was higher (8.7 +/- 1.9 vs 7.6 +/- 1.8, p <0.0001) for patients who underwent previous commissurotomy. Baseline mitral valve area was comparable between the 2 groups (0.96 +/- 0.21 vs 0.93 +/- 0.24 cm(2)). Immediate results were satisfactory, although slightly less favorable after previous commissurotomy, with a final mitral valve area of 2.01 +/- 0.30 versus 2.12 +/- 0.36 cm(2) (p <0.0001), and a residual transvalvular gradient of 5.0 +/- 3.6 versus 4.2 +/- 4.1 mm Hg (p = 0.003). The rates of procedural success (93%) and severe complications (4.7%) were comparable between the 2 groups. Thus, PMMC is an effective and safe technique for the treatment of mitral restenosis after previous commissurotomy.
authors.affiliation: Department of Cardiology, Charles Nicolle Hospital, University of Rouen, Rouen, France. Helene.Eltchaninoff@chu-rouen.fr
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012086:Reoperation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D012449:Safety; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016277:Ventricular Function, Left