RESULTS OF PERCUTANEOUS BALLOON MITRAL VALVOTOMY IN YOUNG-ADULTS

The results of percutaneous balloon mitral valvotomy (PBMV) were evaluated in 235 young patients (mean age 29 +/- 11 years) with symptomatic rheumatic mitral stenosis, and the single-balloon Inoue technique was compared with the double-balloon Mansfield technique. PBMV was associated with a significant increase in Gorlin mitral valve area (0.78 +/- 0.23 to 1.61 +/- 0.64 cm2; p <0.001), and improvement in New York Heart Association functional class (2.78 +/- 0.59 te 1.28 +/-0.58; p <0.001). Mitral regurgitation increased significantly (0.4 +/- 0.6 to 1.3 +/- 1.0; p <0.001), but was significant (greater-than-or-equal-to 3+) only in 19 patients (8%). comparison of the Inoue and Mansfield techniques showed a significantly lower Gorlin mitral valve area after PBMV (1.55 +/- 0.56 vs 1.74 +/- 0.74 cm2; p <0.05), but a lower incidence of mitral regurgitation by color Doppler echocardiography (1.1 +/- 0.7 vs 1.5 +/- 0.8; p <0.05) in the Inoue group. Patients were divided into those with nonpliable (valve score >8; group I) and pliable (score less-than-or-equal-to 8; group II) valves. Although significant increases in mitral valve area were obtained in both groups, mitral valve area by planimetry was significantly lower in group I (1.49 +/- 0.46 vs 1.86 +/- 0.44 cm2; p <0.05), whereas there was no difference in the amount of color Doppler mitral regurgitation (1.5 +/- 1.0 vs 1.2 +/- 0.7; p = NS). It is concluded that (1) in young patients with mitral stenosis, PBMV offers excellent palliation even in those with less ideally pliable valves; and (2) although the Inoue technique achieves smaller valve areas, it is accompanied by a lower incidence of mitral regurgitation.