Percutaneous Double Balloon Valvotomy for Severe Rheumatic Mitral Stenosis Carlos E. Ruiz, MD, John W. Allen, MD, and Francis Y.K. Lau, MD
Percutaneous double balloon valvotomy for severe rheumatic mitral stenosis was successfully performed in 261 of 265 consecutive patients. The changes evoked were a decrease of the mean transvalvulargradiifrom16f7toSf3mmHg,an increase in cardiac output from 3s f 1.0 liters/min to 5.4 f 1.5 liters/min and an increase in mitral valveareafrom0.86f0.24 cm2t02.41f0.S4 cm?. The mean pulmonary artery pressure de-
creasedfrom37~13mmHgto27f12mmHg and the pulmonary
urgical commissurotomy is an established treatment for mitral stenosis (MS). Nonsurgical balloon valvotomy for rheumatic MS was first reported by Inoue et al’ in 1984. Since then, balloon valvotomy has emerged as an alternative treatment. We feel our series of 285 double balloon valvotomy patients will help clarify the short-term hemodynamic response and complications of percutaneous mitral valvotomy. This study defines the success rate, short-term hemodynamic results and complications in 285 patients with symptomatic, rheumatic MS who underwent percutaneous double balloon valvotomy.
from 307 f 181 to 236 f 122 dynes/s/cm-5. Symptomatic improvement occurred in 272 of the 265 (95%) patients. There were 3 procedure-related deaths (1%). Postdilatation mitral regurgitation was not significant in most patients. Therefore, this procedwe can be performed at a low risk with effective results and a fast recovery. (Am J Cardiol1960;65:473477)
From the Department of Interventional Cardiology, The Heart Institute, Hospital of the Good Samaritan, Los Angeles, California. Manuscript received August 22, 1988; revised manuscript received and accepted October 18, 1989. Address for reprints: Carlos E. Ruiz, MD, Interventional Cardiology, Lcma Linda University Service, The Heart Institute, Hospital of the Good Samaritan, 616 South Witmer Street, Los Angeles, California 90017.
METHODS Patients: From February 1986 through August 1989, 311 consecutive patients underwent percutaneous mitral balloon valvotomy and, of these, 285 were by the double balloon technique. This group was made up of 48 males and 237 females with a mean age of 44 f 14 years (range 14 to 83). The duration of symptoms ranged from 1 to 40 years. There were no patients in the New York Heart Association functional class I; 92 were in class II, 149 were in class III and 44 were in class IV. Atria1 fibrillation was present in 95 patients. Patients with thromboembolic events of