PMID- 10745546
OWN - NLM
STAT- MEDLINE
DCOM- 20050414
LR  - 20121115
IS  - 1042-3931 (Print)
IS  - 1042-3931 (Linking)
VI  - 11
IP  - 6
DP  - 1999 Jun
TI  - Percutaneous transvenous mitral commissurotomy for significant calcific mitral 
      stenosis: utility of the stepwise balloon dilatation technique and follow-up 
      results.
PG  - 345-50
AB  - The present study examined the utility of the stepwise balloon dilatation 
      technique in 41 patients with significant calcific mitral stenosis undergoing 
      percutaneous transvenous mitral commissurotomy (PTMC). Thirty-five patients 
      (85.4%) had a successful procedure; one patient developed cardiac tamponade and 
      underwent mitral valve replacement. The mitral valve area increased from 0.9 +/- 
      0.2 cm2 to 1.7 +/- 0.3 cm2 following PTMC. Increase in mitral regurgitation (MR) 
      was seen in 11 patients (26.8%). All patients showed improvement in functional 
      class of > or =1 level following PTMC, which was sustained in 34 patients at 
      follow-up. At a mean follow-up period of 20 +/- 12 months (range 3-51 months) in 
      35 patients, 26 patients (74.3%) were in New York Heart Association (NYHA) 
      functional Class I, 8 patients (22.9%) were in NYHA Class II, and 1 patient 
      (2.8%) was in NYHA Class III. The cumulative 4-year cardiac event-free survival 
      rate was 81.8%. However, patients with grade 4+ calcification had only 50% 
      event-free survival rate. At follow-up, an increased incidence of cardiac events 
      was seen in female patients as compared with male patients (83.3% versus 16.7%). 
      Restenosis was seen in 3 patients (8.6%). One patient underwent repeat PTMC 37 
      months after the initial procedure. There was no incidence of death or mitral 
      valve replacement at follow-up. We conclude that the stepwise balloon dilatation 
      technique can be safely and effectively applied for patients with significant 
      calcific mitral stenosis to achieve an optimal mitral valve area with low 
      incidence of significant increase in MR. Favorable long-term benefits also accrue 
      in the form of improved functional status and low incidence of repeat procedures 
      (repeat PTMC or mitral valve replacement). The majority of patients (74.3%) were 
      in NYHA functional class I without medication. Patients with grade 4+ 
      calcification show less benefit from PTMC and may be considered for mitral valve 
      replacement. Cardiac events occur more frequently in female patients than in male 
      patients during follow-up.
FAU - Abraham, K A
AU  - Abraham KA
AD  - Institute for Cardiac Treatment and Research, Railway Hospital, Ayanavaram, 
      Chennai-600 023, India.
FAU - Chandrasekar, B
AU  - Chandrasekar B
FAU - Rajagopal, S
AU  - Rajagopal S
FAU - Somanath, H S
AU  - Somanath HS
FAU - Sudarsana, G
AU  - Sudarsana G
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - J Invasive Cardiol
JT  - The Journal of invasive cardiology
JID - 8917477
SB  - IM
CIN - J Invasive Cardiol. 1999 Jun;11(6):359-61. PMID: 10745550
CIN - J Invasive Cardiol. 1999 Jun;11(6):362-3. PMID: 10745551
CIN - J Invasive Cardiol. 1999 Aug;11(8):461; author reply 461-2. PMID: 10745574
MH  - Adult
MH  - *Balloon Occlusion
MH  - Calcinosis/*complications
MH  - Catheterization/adverse effects/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Stenosis/*etiology/*therapy
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2000/04/04 00:00
MHDA- 2005/04/15 09:00
CRDT- 2000/04/04 00:00
PHST- 2000/04/04 00:00 [pubmed]
PHST- 2005/04/15 09:00 [medline]
PHST- 2000/04/04 00:00 [entrez]
PST - ppublish
SO  - J Invasive Cardiol. 1999 Jun;11(6):345-50.