title: Percutaneous transvenous mitral commissurotomy using metallic commissurotome: long-term follow-up results.
abstract: BACKGROUND
  We report the long-term follow-up results of percutaneous transvenous mitral commissurotomy (PTMC) using metallic commissurotome, which is proposed as an alternative to Inoue balloon use.
  
  
  METHODS
  PTMC using a metallic commissurotome was performed in 248 patients (65 men) by the anterograde transseptal technique. Of the 248, 64 of the procedures were for mitral restenosis after previous valvotomy.
  
  
  RESULTS
  The procedure was successful in 230 patients (92.7%). Following PTMC, the transmitral gradient decreased from 14.54 +/- 5.79 mmHg to 4.26 +/- 2.82 mmHg (p less than or equal to 0.001). The mitral valve area (MVA) increased from 0.85 +/- 0.12 cm2 to 1.95 +/- 0.31 cm2 (p less than or equal to 0.001). One patient died due to left ventricular perforation (mortality rate = 0.41%). Another patient who developed a left ventricular tear underwent repair of the tear along with open mitral valvotomy. Four patients developed significant mitral regurgitation (MR) from a tear of valve leaflets and had to undergo emergency mitral valve replacement. One patient had a transient ischemic attack and 5 patients developed moderate MR caused by excessive split of valve commissures. The mean follow up period was 3.34 +/- 0.66 years. Six patients were lost to follow up. Seven of the remaining 224 patients developed mitral restenosis. At follow up, the mean pressure gradient across the mitral valve assessed by echocardiography was 6.09 +/- 3.12 mmHg. The mean mitral valve area decreased to 1.67 +/- 0.34 cm2, but clinical improvement persisted in most of the patients.
  
  
  CONCLUSIONS
  PTMC with metallic commissurotomy is safe and produced good results which were sustained at a follow-up period of more than 3 years.
authors.affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
authors.forename: S
authors.initials: S
authors.lastname: Harikrishnan
authors.forename: Anil
authors.initials: A
authors.lastname: Bhat
authors.forename: Jaganmohan
authors.initials: J
authors.lastname: Tharakan
authors.forename: Thomas
authors.initials: T
authors.lastname: Titus
authors.forename: Ajith
authors.initials: A
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Sivasankaran
authors.forename: K M
authors.initials: KM
authors.lastname: Krishnamoorthy
mesh_terms: D000328:Adult; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002986:Clinical Trials as Topic; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008670:Metals; D008944:Mitral Valve Insufficiency / Q000209:etiology; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D008670:Metals