(Circulation. 1998;97:223-226.)
© 1998 American Heart Association, Inc.
Farewell to Surgical Mitral Commissurotomy for Many Patients
Igor F. Palacios, MD
From Massachusetts General Hospital, Harvard Medical School, Boston,
Mass.
Correspondence to Igor F. Palacios, MD, Cardiac Catheterization Laboratory and Interventional Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114. E-Mail palacios@olorin.mgh.harvard.edu
Key Words: : Editorials • mitral valve • surgery • balloon
Percutaneous mitral balloon valvotomy
(PMV) has been accepted as an alternative to surgical mitral
commissurotomy in the treatment of patients with
symptomatic rheumatic mitral stenosis. Previous
studies have demonstrated that PMV produces good immediate and
long-term follow-up results in a selected group of patients with mitral
stenosis.1 2 3 4
Hemodynamic and clinical improvement is achieved in the
majority of patients with rheumatic mitral stenosis. PMV
resulted in a significant decrease in mitral gradient and an increase
in mitral valve area with minimal morbidity and mortality. The majority
of patients have a marked clinical improvement, and the
hemodynamic and clinical improvement produced by PMV
persist at long-term follow-up.2 3 4 On the other hand,
surgical mitral commissurotomy has been used successfully for many
years to treat patients with mitral stenosis. The results of
closed or open surgical mitral commissurotomy have demonstrated
favorable immediate and long-term hemodynamic and
symptomatic improvement in selected patients with rheumatic
mitral stenosis.
Interpretation of long-term clinical follow-up of patients
undergoing percutaneous mitral balloon valvuloplasty as
well as their comparison with surgical commissurotomy series are
confounded by heterogeneity in the patient population.
Only few randomized studies have compared the results of PMV with those
of surgical commissurotomy. In this issue of the journal, Farhat et
al5 reported the results of a randomized trial designed to
compare the immediate and long-term results of double-balloon PMV
versus those of open and closed surgical mitral commissurotomy in a
cohort of patients with severe rheumatic mitral stenosis. These
patients were, from the clinical and morphological point . . . [Full Text of this Article]
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