Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
« Previous Article | Table of Contents
Circulation. 2000;101:e91

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cheng, T. O.
Right arrow Articles by Macaya, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cheng, T. O.
Right arrow Articles by Macaya, C.
Related Collections
Right arrow Restenosis
Right arrow Valvular heart disease
Right arrow Catheter-based coronary and valvular interventions: other
Right arrow CV surgery: valvular disease

(Circulation. 2000;101:e91.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Long-Term Results of Percutaneous Balloon Mitral Valvuloplasty Using the Inoue Balloon Catheter Technique

Tsung O. Cheng, MD

Professor of Medicine The George Washington University, Washington, DC


*    Introduction
up arrowTop
 *Introduction
down arrowReferences
 down arrowIntroduction 
 down arrowReferences 
 
To the Editor:

I read with interest the article on long-term follow-up after percutaneous mitral valvuloplasty with the Inoue balloon catheter by Hernandez et al.1 They reported a restenosis rate of 39% at 7 years.

My colleagues from China and I recently reported our experience with the same technique in a follow-up study up to 11 years in the first 202 patients2 among the original 4832 patients treated in China.3 The restenosis rate was 8%, which is very respectable and actually better than that after surgical closed commissurotomy (25% to 28%).2 Why the restenosis rate in the Chinese patients is much lower than that in the Spanish patients is unclear.

Our experience as well as a series of recent reports of excellent long-term results have strengthened the previous conclusion that percutaneous mitral valvuloplasty using the Inoue balloon technique should be the procedure of first choice in most patients with mitral stenosis worldwide.4


*    References
up arrowTop
 up arrowIntroduction
 *References
down arrowIntroduction 
 down arrowReferences 
 

  1. Hernandez R, Bañuelos C, Alfonso F, Goicolea J, Fernández-Ortiz A, Escaned J, Azcona L, Almeria C, Macaya C. Long-term clinical and echocardiographic follow-up after percutaneous mitral valvuloplasty with the Inoue balloon. Circulation. 1999;99:1580–1586.[Abstract/Free Full Text]
  2. Chen C-R, Cheng TO, Chen J-Y, Huang Y-G, Huang T, Zhang B. Long-term results of percutaneous balloon mitral valvuloplasty for mitral stenosis: a follow-up study to 11 years in 202 patients. Cathet Cardiovasc Diagn. 1998;43:132–139.[Medline] [Order article via Infotrieve]
  3. Chen C, Cheng TO, for the Multicenter Study Group. Percutaneous balloon mitral valvuloplasty using Inoue technique: a multicenter study of 4832 patients in China. Am Heart J. 1995;129:1197–1204.[Medline] [Order article via Infotrieve]
  4. Cheng TO, Holmes DR Jr. Percutaneous balloon mitral valvuloplasty by the Inoue balloon technique: the procedure of choice for treatment of mitral stenosis. Am J Cardiol. 1998;81:624–628.[Medline] [Order article via Infotrieve]

Response

Rosa Hernandez, MD; Camino Bañuelos, MD; Fernando Alfonso, MD; Javier Goicolea, MD; Antonio Fernández-Ortiz; Javier Escaned, MD; Luis Azcona, MD; Carlos Almeria, MD; Carlos Macaya

Hospital Universitario San Carlos, Madrid, Spain


*    Introduction 
up arrowTop
 up arrowIntroduction
 up arrowReferences
 *Introduction 
down arrowReferences 
 
Dr Cheng remarks on the discrepancy between the restenosis rate reported in our articleR1 (39% at 7 years) and that reported by him and his colleaguesR2 (8%) after percutaneous valvuloplasty with the Inoue balloon. They speculate whether or not baseline differences in Spanish and Chinese populations may account for such a striking difference.

We believe that this difference is more apparent that real. Our restenosis rate after a mean follow-up of 39±23 months was 10%, rather similar to that reported by them (8% after 3.7±2.1 years). A different methodology may account for these differences: (1) Our analysis took under consideration not only the incidence of restenosis in the whole series, but the time after the procedure as well. Kaplan-Meier curves for restenosis (defined as loss of 50% of gain by Doppler echocardiography) revealed a restenosis rate of 4% at 3 years, 18% at 5 years, and 39% at 7 years. (2) In our series, not all patients included in the restenosis definition were severely symptomatic (only 30 of 56, or 53%, were in class III), a requisite included in the definition of restenosis by Cheng et al.

Nevertheless, as suggested by Dr Cheng, there were several differences in baseline populations. Our patients were older (54±13 versus 38±12 years) and more frequently in atrial fibrillation (57% versus 22%) than those in the Chinese series. Although immediate and last follow-up results are difficult to compare because we reported Doppler data and Cheng et al reported hemodynamic data, the repeat valvuloplasty rate was 1% and 2% in both series, and the mitral replacement rate was 10% and 6% in the Spanish and Chinese series, respectively.

We fully agree with Dr Cheng that at the present time, percutaneous mitral valvuloplasty with the Inoue balloon is the treatment of choice for most patients with symptomatic mitral stenosis worldwide.


*    References 
up arrowTop
 up arrowIntroduction
 up arrowReferences
 up arrowIntroduction 
 *References 
 

  1. Hernandez R, Bañuelos C, Alfonso F, Goicolea J, Fernández-Ortiz A, Escaned J, Azcona L, Almería C, Macaya C. Long-term clinical and echocardiographic follow-up after percutaneous mitral valvuloplasty with the Inoue balloon. Circulation. 1999;99:1580–1586.
  2. Chen CR, Cheng TO, Chen JY, Huang YG, Huang T, Zhang B. Long-term results of percutaneous balloon mitral valvuloplasty for mitral stenosis: a follow-up study to 11 years in 202 patients. Cath Cardiovasc Diagn.. 1998;43:132–139.




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cheng, T. O.
Right arrow Articles by Macaya, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cheng, T. O.
Right arrow Articles by Macaya, C.
Related Collections
Right arrow Restenosis
Right arrow Valvular heart disease
Right arrow Catheter-based coronary and valvular interventions: other
Right arrow CV surgery: valvular disease

Circulation Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search
Copyright © 2000 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.