LATE HEMODYNAMIC-CHANGES IN PERCUTANEOUS MITRAL VALVULOPLASTY

Percutaneous mitral valvuloplasty (PMV) was performed in 57 patients with mitral stenosis. Twenty-three women and 34 men (mean age 28±10 mean ± SD) were included in the study. A single-balloon (trefoil or bifoil) technique was used in 49 patients and a double-balloon (trefoil ± monofoil) technique in eight. After a 3-month follow-up period, right- and left-sided cardiac catheterization was repeated. In the single-balloon group there was improvement in the mitral valve gradient (16.10±5.99 to 4.41±2.03 mm Hg), mean left atrial pressure (22.65±6.13 to 9.76±3.01 mm Hg), and mitral valve area (0.89±0.22 to 1.95±0.46 cm2/m2). Mean pulmonary artery pressure and mean pulmonary wedge pressure decreased to 19.33±4.19 mm Hg and 10.73±2.60 mm Hg from 32.94±7.90 mm Hg and 21.49±5.98 mm Hg. Cardiac output increased to 6.86±0.56 L/min from 5.57±0.66. All improvements were statistically significant (p<0.001). In the double-balloon study group, mitral valve gradient (23.75±2.77 to 4.50±1.94 mm Hg), mean left atrial pressure (31.63±3.57 to 9.50±1.94 mm Hg), mean pulmonary artery pressure (44.00±6.36 to 18.88±7.10), and mean pulmonary wedge pressure (29.25±3.73 to 10.25±1.85 mm Hg) all improved significantly (p<0.001). Mitral valve area and cardiac output increased from 0.89±0.15 to 2.44±0.44 cm2/m2 (p<0.001) and from 5.46±0.76 to 7.15±0.52 L/min (p<0.002), respectively. Area change and percentage of area change in the double-balloon group were 1.61±0.44 cm2/m2 and 179.50±49%, respectively. In the single-balloon group, area change and percentage of area change were 1.12±0.1 cm2/m2 and 126.12±53.07%, respectively. Three-month follow-up results indicate that PMV is a safe and effective treatment in patients with rheumatic mitral stenosis. Use of the double-balloon technique provided greater reductions in gradient and greater dilatation of the mitral valve. © 1990 Mosby-Year Book, Inc.