MITRAL VALVE REPLACEMENT AFTER PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY-A REVIEW OF 9 CASES-

Nine patients underwent mitral valve replacement (MVR) after percutaneous transvenous mitral commissiurotomy (PTMC) because of recurrent mitral stenosis (MS) in 6, mitral regurgitation (III°) in 1, left ventricular rupture in 1, and aortic stenosis with mild recurrent MS in 1. There were two men and seven women, 47 to 71 years old at the time of surgery (average age: 62.2). Two of the nine patients had had a previous operation (open mitral commissurotomy) from 10 to 16 years earlier. All of them presented atrial fibrillation. MVR was performed immediately to 83 months (a mean of 35 months) after the patient had undergone PTMC. Six of them underwent MVR only, two had MVR+tricuspid annuloplasty (TAP), one had MVR+TAP +coronary artery bypass grafting, and one needed emergency MVR+left ventricular repair. The intraoperative findings of the 6 with recurrent MS included thickened leaflets with subvalvular thickening and fusion, and bilateral commissural calcification. Of these 9 parients, seven survived surgery, one died of multiple organ failure secondary to low output syndrome (LOS), and one died of LOS and cerebral infarction. Seven patients are now in NYHA Class I to II at a mean follow-up period of 39.7 months. PTMC in shown to be an effective and safe treatment for MS. However, we emphasize that the indication of PTMC ought to be strict for aged people. This procedure should be performed on the basis of Doppler echo findings of the mitral complex.