Mitral valve replacement after percutaneous transluminal mitral commissurotomy

Abstract

Objectives: We reviewed our experience of mitral valve replacement (MVR) after percutaneous transluminal mitral commissurotomy (PTMC) for mitral stenosis (MS). Methods: From December 1987 to December 2001, PTMC was conducted in 75 patients with symptomatic rheumatic MS. At mean follow-up of 8.4±3.5 years, 11 patients (14.7%) underwent MVR for mitral restenosis (9 cases) and mitral regurgitation (MR) (2 cases). The mean interval between PTMC and MVR was 5.2±3.2 years. Results: There were 2 hospital deaths (due to low output syndrome and mediastinitis) and 2 complications (prosthetic valve endocarditis and left ventricular rupture). The mitral valve area (MVA) at pre-PTMC, post-PTMC and pre-MVR was 1.02±0.48 cm²,1.55±0.59 cm²,1.04±0.23 cm², respectively. The MVA significantly increased after PTMC (p<0.01), but decreased significantly to the pre-PTMC value at pre-MVR (p<0.05). The left atrial dimension (LAD) significantly increased from 50.4±10.8 mm at pre-PTMC to 61.1±13.1 mm at pre-MVR (p<0.05). The number of significant tricuspid regurgitation (TR) cases increased from 2 at pre-PTMC to 5 at pre-MVR. The New York Heart Association class got better after PTMC (3 cases in class HI at pre-PTMC to 0 at post-PTMC), but at pre-MVR, deteriorated to the same level at pre-PTMC (4 cases in class III). Conclusions: Our results of MVR after PTMC were reasonable to be considered despite their high risk at MVR resulting in 2 hospital deaths. For the reliable relief of MS and control of TR, not PTMC but MVR combined with tricuspid annuloplasty may be preferable in such two cases suffering from congestive heart failure with significant TR at first intervention. Close follow-ups like periodic ultrasonic cardiography studies should be conducted to gain more information on the mitral restenosis, TR deterioration and dilatation of the cardiac chambers.