CLINICAL FOLLOW-UP OF PATIENTS UNDERGOING PERCUTANEOUS MITRAL BALLOON VALVOTOMY

Background This study is the clinical follow-up (20+/-12 months; range, 6 to 49 months) of 327 patients who had percutaneous mitral balloon valvotomy (PMV) at the Massachusetts General Hospital. Methods and Results There were seven in-hospital deaths. Patients were divided into two groups according to their echocardiographic score; 211 patients had echocardiographic scores less than or equal to 8 and 116, echocardiographic scores >8. Patients with echocardiographic scores >8 were older (64+/-11 versus 48+/-14 years, P<.01), and more had atrial fibrillation (65% versus 40%, P<.01), calcium under fluoroscopy (81% versus 29%, P<.01), and previous surgical commissurotomy (30% versus 16%, P<.01) than patients with echocardiographic scores less than or equal to 8. With PMV, mitral valve area increased from 1.0+/-0.3 to 2.2+/-0.8 cm(2) in patients with echocardiographic scores less than or equal to 8 and from 0.8+/-1 to 1.7+/-0.7 cm(2) in those with echocardiographic scores >8. Rates of survival (98+/-2% versus 72+/-11%), survival with freedom from mitral valve replacement (91+/-4% versus 55+/-13%), and survival with freedom from combined events (79+/-10% versus 39+/-18%) at follow-up were greater in patients with echocardiographic scores less than or equal to 8 (P<.00005). Cox regression analysis identified the echocardiographic score as the most important unfavorable intermediate long-term follow-up prediction factor after PMV. Conclusions The excellent intermediate long-term clinical follow-up of patients with echocardiographic score less than or equal to 8 and no calcified mitral valves suggests that PMV may be the treatment of choice in this group of patients.