From the Division of Cardiology, Department of Medicine, Fattouma
Bourguiba University Hospital, Tunisia.
Background—Percutaneous
balloon mitral commissurotomy (BMC) has been proposed as an alternative
to surgical closed mitral commissurotomy (CMC) and open mitral
commissurotomy (OMC) for the management of rheumatic mitral valve
stenosis (MS).
Methods and Results—We conducted a prospective, randomized trial
comparing the results of the 3 procedures in 90 patients (30 patients
in each group) with severe pliable MS. Cardiac
catheterization was performed in all patients before
and at 6 months after each procedure. All patients had clinical and
echocardiographic evaluation initially and throughout
the 7-year follow-up period. Gorlin mitral valve area (MVA) increased
much more after BMC (from 0.9±0.16 to 2.2±0.4 cm2) and
OMC (from 0.9±0.2 to 2.2±0.4 cm2) than after CMC (from
0.9±0.2 to 1.6±0.4 cm2). Residual MS (MVA <1.5
cm2) was 0% after BMC or OMC and 27% after CMC. There was
no early or late mortality or thromboembolism among the three groups.
At 7-year follow-up, echocardiographic MVA was similar
and greater after BMC and OMC (1.8±0.4 cm2) than after CMC
(1.3±0.3 cm2; P<.001). Restenosis
(MVA <1.5 cm2) rate was 6.6% after BMC or OMC versus 37%
after CMC. Residual atrial septal defect was present in 2 patients
and severe grade 3 mitral regurgitation was present
in 1 patient in the BMC group. Eighty-seven percent of patients after
BMC and 90% of patients after OMC were in New York Heart Association
functional class I versus 33% (P<.0001) after CMC.
Freedom from reintervention was 90% after BMC, 93% after OMC, and
50% after CMC.
Conclusions—In contrast to surgical CMC, BMC and OMC produce
excellent and comparable early hemodynamic improvement
and are associated with a lower rate of residual stenosis and
restenosis and need for reintervention. However, the good
results, lower cost, and elimination of drawbacks of thoracotomy and
cardiopulmonary bypass indicate that BMC should be the
treatment of choice for patients with tight pliable rheumatic MS.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Percutaneous Balloon Versus Surgical Closed and Open Mitral Commissurotomy
Seven-Year Follow-up Results of a Randomized Trial
Key Words: balloon • valves • mitral commissurotomy
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