Clinical Follow-up of Patients Undergoing Percutaneous Mitral Balloon Valvotomy

Abstract

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 ≤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 ≤8. With PMV, mitral valve area increased from 1.0±0.3 to 2.2±0.8 cm 2 in patients with echocardiographic scores ≤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 ≤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 ≤8 and no calcified mitral valves suggests that PMV may be the treatment of choice in this group of patients.