PMID- 1617794
OWN - NLM
STAT- MEDLINE
DCOM- 19920806
LR  - 20190623
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 86
IP  - 1
DP  - 1992 Jul
TI  - Balloon mitral commissurotomy after previous surgical commissurotomy. The 
      National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry 
      participants.
PG  - 91-9
AB  - BACKGROUND: Mitral restenosis after surgical mitral commissurotomy often occurs 
      within 5-15 years, necessitating a repeat procedure. Balloon mitral 
      commissurotomy (BMC) has been advocated as an alternative to repeat surgery for 
      mitral restenosis. METHODS AND RESULTS: The purposes of this study are to 
      determine the short- and intermediate-term outcomes of patients undergoing BMC 
      after previous surgical commissurotomy, to compare these patients with those 
      undergoing balloon mitral commissurotomy as an initial procedure, and to 
      elucidate the multivariate determinants of acute procedural and clinical outcome. 
      Of 738 patients undergoing BMC as part of the National Heart, Lung, and Blood 
      Institute Balloon Valvuloplasty Registry, 133 underwent BMC after previous 
      surgical mitral commissurotomy. Prospective data obtained included demographic, 
      hemodynamic, echocardiographic, and clinical follow-up. BMC after previous 
      surgical commissurotomy produced a significant reduction in transvalvular 
      gradient from 13 +/- 5 to 6 +/- 3 mm Hg (p less than 0.0001) and an increase in 
      mitral valve area from 1.0 +/- 0.3 to 1.8 +/- 0.8 cm2 (p less than 0.0001). BMC 
      as an initial procedure increased valve area from 1.0 +/- 0.4 to 2.0 +/- 0.8 cm2 
      (p less than 0.0001) (p = 0.03 versus prior surgery). Baseline characteristics 
      including mitral valve echo score were similar for both groups. Comparing 6-month 
      status in patients with prior surgery to those without, 80% versus 90% were New 
      York Heart Association (NYHA) functional class I or II (p = 0.004). Mortality was 
      similar. In patients with previous mitral valve surgery, multivariate predictors 
      of improvement in 6-month clinical status included the experience of the center 
      (p = 0.006), lower echocardiographic score (p = 0.001), and lower left 
      ventricular end-diastolic pressure (p = 0.008). Multivariate determinants of a 
      final mitral valve area greater than or equal to 1.5 cm2 were a lower baseline 
      NYHA functional class (p = 0.003) and lower mitral valve echocardiographic score 
      (p = 0.008). CONCLUSIONS: BMC after previous surgical mitral commissurotomy 
      results in similar hemodynamic changes as in patients undergoing BMC as an 
      initial procedure. Symptomatic improvement at 6 months is slightly less frequent 
      in prior commissurotomy patients. Patients with favorable valvular morphology and 
      preserved left ventricular function who undergo BMC in experienced centers are 
      most likely to achieve symptomatic improvement after previous surgical 
      commissurotomy. In general, BMC is an effective treatment for mitral restenosis 
      after previous surgical commissurotomy.
FAU - Davidson, C J
AU  - Davidson CJ
AD  - National Heart, Lung, and Blood Institute, Bethesda, Md.
FAU - Bashore, T M
AU  - Bashore TM
FAU - Mickel, M
AU  - Mickel M
FAU - Davis, K
AU  - Davis K
LA  - eng
GR  - N01-HV-78100/HV/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - *Catheterization
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Stenosis/physiopathology/surgery/*therapy
MH  - Multivariate Analysis
MH  - Postoperative Complications
MH  - Reoperation
EDAT- 1992/07/01 00:00
MHDA- 1992/07/01 00:01
CRDT- 1992/07/01 00:00
PHST- 1992/07/01 00:00 [pubmed]
PHST- 1992/07/01 00:01 [medline]
PHST- 1992/07/01 00:00 [entrez]
AID - 10.1161/01.cir.86.1.91 [doi]
PST - ppublish
SO  - Circulation. 1992 Jul;86(1):91-9. doi: 10.1161/01.cir.86.1.91.