VALVUIAR
HEARY DISEASE
Long-Term Results of Percutaneous Mitral Valvuloplasty with the lnoue Balloon Catheter Chuan-Rong Chen, MD, Tsung 0. Cheng, MD, Ji-Yan Chen, MD, Ying-Ling Zhou, MD, Jia Mei, MD, and Tie-Zheng Ma, MD The initial 85 patients who successfully underwent percutaneous mitral valvuloplasty (PMV) with the htoue balloon catheter at the Guangdong Cardiovascular Instttute between November 1985 and November 1688 had a mean follow-up period of S f 1 year (range 43 to 79 months). Before and after PMV and at follow-up, mean diastolic mitral gradients by the catheter method were 17.5 f 6.2,3.1 f 3.3 and 3.3 f 3.4 mm Hg, respe&vely (p O.OS after PMV vs follow-up). Mean diastolic mitral gradients by the Doppler methodwere18f6,8fSand9fSmmHg,respecttvely (p O.OS after PMV VI follow-up). Mitral valve areas by the echo-Doppler method were 1.1 f 0.3,2.0 f 0.4 and 1.8 f 0.5 cm?, respectively (p O.OS after PMV vs follow-up). Phonocardiographic and vectorcardtographic studies, and cardkpulmonary exercise tesUng showed stgnifkant improvement after PMV and at fotlow-up. Functional status before PMV was New York Heart Association class IV in 2 patients, class RI in 52, and class II in 31; at fotlow-up, the status was class I in 74, class II in 6, and class RI in 5. All 5 patients (6.8%) in class RI developed mitral restenosir; in all 5, severe mitral cakifkation and subvalvular fudon were found by 2-dhnenshmal echocardiography. It is concluded that PMV wtth the lnoue balloon catheter can achieve excellent and sustained long-term results in relieving symptomatic, rheumatic mttral stenods in patients without severe mitral cakifkatton and subvalvular fusion. (Am J Cardiol 1662;70:144S-1448)
P
ercutaneousballoon mitral valvuloplasty as an alternative to surgical commissurotomy was first describedby Inoue et al’ in 1984. Subsequentrep~rt.$*-~*have confirmed its efficacy. There have been few long-term follow-up studies reported. We previously reported the early4 and latei results in a series of patients who underwent percutaneousmitral valvuloplasty (PMV) with the Inoue balloon catheter at the Guangdong Cardiovascular Institute. In this study, we present the long-term outcome of 85 patients in whom the follow-up period was extendedto 43 to 79 months (mean 5 f 1 year). MEWlOO Patkntsz Between November 1985 and November
1988, 85 patients (23 male and 62 female, aged 33.6 f 7.2 years, range 15 to 56) successfullyunderwent PMV with the Inoue balloon catheter at the Guangdong Cardiovascular Institute. Mean duration of illness was 7.0 f 5.2 years (range 4 months to 24 years). Fourteen patients had associatedmitral regurgitation (1+/4+ in 11, and 2+/4+ in 3), 21 had aortic regurgitation (1+/4+ in 15, and 2+/4+ in 6), and 2 had aortic stenosis (aortic systolic peak gradient 2 years.The other 4 patients underwent mitral valve replacement,and severe mitral stenosiswith severecalcification and subvalvular fusion was found at operation in all. Systolic pulmonary artery pressurewas 52 f 22, 36 f 17 and 37 f 18 mm Hg before and after PMV and at follow-up, respectively (p 0.05 after PMV vs followup). Mean left atria1 pressurewas 21 f 7, 10 f 9 and 11 f 10 mm Hg before and after PMV and at followup, respectively(p 0.05 after PMV vs follow-up) (Figure 2). Mean diastolic mitral gradient measuredby the catheter method was 18 f 7, 3 f 3 and 3 f 3 mm Hg before and after PMV and at follow-up, respectively (p 0.05 after PMV vs followup) (Figure 3). By the Doppler method, mean diastolic mitral gradient was 17 f 6, 8 f 5 and 9 f 5 mm Hg before and after PMV and at follow-up, respectively(p 0.05 after PMV vs follow-up) (Figure 3). Mitral valve area r
Catheter Method
Doppler Method
)
‘pQ.OS Post vs Fu
1 0
Post-PMV
I
‘~0.001 “p~0.05
Pre VI) Post & Pre vs Fu Post vs Fu
T*
2
20
Pre Post Fu
T*
2 1
0
1446
Pre
Post
Fu
THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 70
0
Pre-PMV
DECEMBER 1. 1992
’ Post-PMV ’
Fu
I
measured by 2-dimensional echo-Doppler method was 1.1 f 0.3, 2.0 f 0.4 and 1.8 f 0.5 cm2before and after PMV and at follow-up, respectively (p 0.05 after PMV vs follow-up) (Figure 4). Mean left atria1 dimension measuredby echocardiographywas 42 f 6,37 f 6 and 37 f 6 mm before and after PMV and at followup, respectively (p 0.05 before versus after; tp
HEARY DISEASE
Long-Term Results of Percutaneous Mitral Valvuloplasty with the lnoue Balloon Catheter Chuan-Rong Chen, MD, Tsung 0. Cheng, MD, Ji-Yan Chen, MD, Ying-Ling Zhou, MD, Jia Mei, MD, and Tie-Zheng Ma, MD The initial 85 patients who successfully underwent percutaneous mitral valvuloplasty (PMV) with the htoue balloon catheter at the Guangdong Cardiovascular Instttute between November 1985 and November 1688 had a mean follow-up period of S f 1 year (range 43 to 79 months). Before and after PMV and at follow-up, mean diastolic mitral gradients by the catheter method were 17.5 f 6.2,3.1 f 3.3 and 3.3 f 3.4 mm Hg, respe&vely (p O.OS after PMV vs follow-up). Mean diastolic mitral gradients by the Doppler methodwere18f6,8fSand9fSmmHg,respecttvely (p O.OS after PMV VI follow-up). Mitral valve areas by the echo-Doppler method were 1.1 f 0.3,2.0 f 0.4 and 1.8 f 0.5 cm?, respectively (p O.OS after PMV vs follow-up). Phonocardiographic and vectorcardtographic studies, and cardkpulmonary exercise tesUng showed stgnifkant improvement after PMV and at fotlow-up. Functional status before PMV was New York Heart Association class IV in 2 patients, class RI in 52, and class II in 31; at fotlow-up, the status was class I in 74, class II in 6, and class RI in 5. All 5 patients (6.8%) in class RI developed mitral restenosir; in all 5, severe mitral cakifkation and subvalvular fudon were found by 2-dhnenshmal echocardiography. It is concluded that PMV wtth the lnoue balloon catheter can achieve excellent and sustained long-term results in relieving symptomatic, rheumatic mttral stenods in patients without severe mitral cakifkatton and subvalvular fusion. (Am J Cardiol 1662;70:144S-1448)
P
ercutaneousballoon mitral valvuloplasty as an alternative to surgical commissurotomy was first describedby Inoue et al’ in 1984. Subsequentrep~rt.$*-~*have confirmed its efficacy. There have been few long-term follow-up studies reported. We previously reported the early4 and latei results in a series of patients who underwent percutaneousmitral valvuloplasty (PMV) with the Inoue balloon catheter at the Guangdong Cardiovascular Institute. In this study, we present the long-term outcome of 85 patients in whom the follow-up period was extendedto 43 to 79 months (mean 5 f 1 year). MEWlOO Patkntsz Between November 1985 and November
1988, 85 patients (23 male and 62 female, aged 33.6 f 7.2 years, range 15 to 56) successfullyunderwent PMV with the Inoue balloon catheter at the Guangdong Cardiovascular Institute. Mean duration of illness was 7.0 f 5.2 years (range 4 months to 24 years). Fourteen patients had associatedmitral regurgitation (1+/4+ in 11, and 2+/4+ in 3), 21 had aortic regurgitation (1+/4+ in 15, and 2+/4+ in 6), and 2 had aortic stenosis (aortic systolic peak gradient 2 years.The other 4 patients underwent mitral valve replacement,and severe mitral stenosiswith severecalcification and subvalvular fusion was found at operation in all. Systolic pulmonary artery pressurewas 52 f 22, 36 f 17 and 37 f 18 mm Hg before and after PMV and at follow-up, respectively (p 0.05 after PMV vs followup). Mean left atria1 pressurewas 21 f 7, 10 f 9 and 11 f 10 mm Hg before and after PMV and at followup, respectively(p 0.05 after PMV vs follow-up) (Figure 2). Mean diastolic mitral gradient measuredby the catheter method was 18 f 7, 3 f 3 and 3 f 3 mm Hg before and after PMV and at follow-up, respectively (p 0.05 after PMV vs followup) (Figure 3). By the Doppler method, mean diastolic mitral gradient was 17 f 6, 8 f 5 and 9 f 5 mm Hg before and after PMV and at follow-up, respectively(p 0.05 after PMV vs follow-up) (Figure 3). Mitral valve area r
Catheter Method
Doppler Method
)
‘pQ.OS Post vs Fu
1 0
Post-PMV
I
‘~0.001 “p~0.05
Pre VI) Post & Pre vs Fu Post vs Fu
T*
2
20
Pre Post Fu
T*
2 1
0
1446
Pre
Post
Fu
THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 70
0
Pre-PMV
DECEMBER 1. 1992
’ Post-PMV ’
Fu
I
measured by 2-dimensional echo-Doppler method was 1.1 f 0.3, 2.0 f 0.4 and 1.8 f 0.5 cm2before and after PMV and at follow-up, respectively (p 0.05 after PMV vs follow-up) (Figure 4). Mean left atria1 dimension measuredby echocardiographywas 42 f 6,37 f 6 and 37 f 6 mm before and after PMV and at followup, respectively (p 0.05 before versus after; tp
