Percutaneous balloon mitral valvuloplasty in patients with mitral restenosis after previous surgical commissurotomy - A matched comparative study

Background Although the efficacy of percutaneous balloon mitral valvuloplasty in patients with unoperated mitral stenosis has been well documented, there exists less clear-cut data on its effectiveness in patients with mitral restenosis after previous surgical commissurotomy. Accordingly, the purpose of this study was to evaluate our immediate and midterm results of balloon mitral valvuloplasty in this subset of patients with previous mitral surgery. Methods Between October 1991 and August 1995, 29 consecutive patients with mitral restenosis after prior surgical commissurotomy (group 1) underwent Inoue balloon mitral valvuloplasty. They were matched on a patient-to-patient basis with regards to baseline mitral echocardiographic score, mitral valve area, severity of angiographic mitral regurgitation and follow-up duration with 29 other patients with unoperated mitral stenosis (group 2) who underwent balloon mitral valvuloplasty during the same study period. Results Balloon mitral valvuloplasty yielded identical improvements in transmitral gradient and mitral valve area (from 0.8 to 1.6 cm(2)) determined echocardiographically, and similar changes in the severity of mitral regurgitation in both groups of patients. All procedures were successfully completed without major cardiac complications. Follow-up echocardiographic assessment in 73% of patients revealed equal mitral valve area (1.6 cm(2)) and a restenosis rate of 17%, with no difference in the restenosis rate between the two groups. Conclusion Balloon mitral valvuloplasty in selected patients with mitral restenosis after past surgical commissurotomy can be performed safely and with similar immediate and midterm efficacy as in patients with de novo mitral stenosis.