BALLOON VALVULOPLASTY VERSUS CLOSED COMMISSUROTOMY FOR PLIABLE MITRAL-STENOSIS - A PROSPECTIVE HEMODYNAMIC-STUDY

Closed surgical mitral valvotomy is the procedure of choice in most patients with symptomatic pliable mitral stenosis in developing countries. The procedure is efficacious and safe. Mitral valvotomy performed with a balloon has shown similar good results, with infrequent complications in selected subjects. Because there is a paucity of studies comparing the two techniques, this study was undertaken to comp are the results of percutaneous balloon mitral valvuloplasty with those of closed commissurotomy as determined by catheterization studies. Forty-five patients with tight pliable mitral stenosis were randomly assigned to one of two groups: 23 patients had balloon valvuloplasty by the single catheter technique (group I) and 22 underwent closed surgical valvotomy (group II). The two groups were similar with regard to clinical and hemodynamic findings before intervention. Mitral valve area increased from 0.8 +/- 0.3 to 2.1 +/- 0.7 cm2 in group I (p < 0.001) and from 0.7 +/- 0.2 to 1.3 +/- 0.3 cm2 in group II (p < 0.001). Pulmonary artery pressure and pulmonary vascular resistance decreased in both groups, but these changes did not reach statistical significance in group II. Treadmill exercise time increased from 3.8 +/- 2.3 to 7.3 +/- 2.6 min in group I (p < 0.001) and from 4 +/- 2.6 to 5.6 +/- 2.6 min in group II (p < 0.001). There were no deaths. One patient in each group developed moderate (3+) mitral regurgitation. A small interatrial shunt (< 1.5:1) was detected in three patients in group I immediately after the procedure. Thus, despite similar clinical improvement in both groups, there was a significantly larger increase in mitral valve area in the balloon valvuloplasty group. The study results show that balloon valvuloplasty and surgical closed commissurotomy are comparable in safety, but a larger valve area and a greater increase in exercise time are achieved with balloon valvuloplasty.