Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis

Abstract

Objective: To determine the efficacy and safety of percutaneous transvenous mitral commissurotomy(PTMC), using multi-track double balloon technique in juvenile mitral stenosis. Design: Open non-randomised intervention. Setting: Cardiac catheterisation laboratories of The Mater Hospital, The Nairobi Hospital and Kenyatta National Hospital from 1996 to 2001. Patients: Forty five consecutive patients aged less than 21 years with severe pure mitral stenosis and suitable mitral valve apparatus (leaflets, chordae and papillary muscles) for successful commissurotomy. Intervention: Percutaneous transvenous mitral commissurotomy under local anaesthesia. Standard left and right heart catheterisation for mitral valve disease. Trans-septal left atrial entry using standard septal puncture technique and left ventricular position secured by superstiff guide-wire. Double-balloon mitral valvotomy on single guide-wire using multi-track balloon catheters. Main outcome measures: Mitral valve area, left atrial pressures, mitral regurgitation grade, NYHA functional class. Results: Mitral valve area increased from 0.6±0.19cm2 to 1.9±0.19cm2 (p<0.001), left atrial pressures from 30.5±3.9 mmHg to 11.5±3.8 mmHg (p<0.001). Most patients NYHA functional class immediately improved from class III-IV to class I-II. There was no significant changes in grades of mitral regurgitation or significant complications related to the procedure. Conclusions: PTMC in juvenile mitral stenosis using the multi-track technique is safe and effective yielding satisfactory immediate results.