Balloon mitral valvotomy after surgical commissurotomy: clinical and hemodynamic results of a large, single-center study.
OBJECTIVE
Patients with restenosis after open or closed surgical commissurotomy (SC) often demonstrate more severe valve degeneration than patients without prior surgery. This may affect the result of balloon mitral valvotomy (BMV) in this patient group.


METHODS
The immediate- and long-term results (maximum 106 months; mean 26 months) of BMV with the Inoue balloon in patients with prior SC were compared with findings in patients without prior surgery. Between February 1989 and July 2001, a total of 1,156 BMV interventions was performed, of which 127 were conducted in patients (106 women, 21 men; mean age 56 +/- 12 years) with prior SC.


RESULTS
After BMV, the mitral valve area (MVA) increased from 1.0 +/- 0.2 cm2 to 1.6 +/- 0.4 cm2 after SC compared with 1.0 +/- 0.3 cm2 to 1.8 +/- 0.4 cm2 without SC. After three months, the average MVA was 1.7 +/- 0.3 cm2 in both patient groups. The mean NYHA class improved from 2.8 to 2.0 (after SC) versus 2.7 to 1.8 (no SC) three months after BMV. The main complications were cardiac tamponade in three patients (2.4 %), and more than moderate mitral regurgitation (grade 2+) in six (4.7 %) compared to 5.8% in no-SC patients.


CONCLUSIONS
In view of the satisfactory clinical and hemodynamic results, BMV with the Inoue balloon can be considered the treatment of choice for mitral valve restenosis after SC in selected patients.
Neumayer
Ulrike
U
Department of Cardiology, St. Marienhospital Hamm, Germany.
Schmidt
Henning K
HK
Fassbender
Dieter
D
Mannebach
Hermann
H
Bogunovic
Nicola
N
Horstkotte
Dieter
D
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome