Comparação entre comissurotomia e valvoplastia por cateter-balão na estenose mitral. Cinco anos de acompanhamento

Abstract

Objective: To compare clinical and laboratory data in patients with mitral stenosis undergoing open commissurotomy or balloon valvuloplasty, who were followed up for 5 years. Methods: Eighty-one patients were prospectively assessed prior to the procedure (PRE) and immediately after the procedure, in the immediate postoperative period (IPO), and followed up yearly for 5 years (P012M, P024M, P036M, P048M, and P060M). They were randomized into the following 2 groups: GC (group undergoing open commissurotomy): 37 patients (32.4 ± 7.2 years; 89.2% females); and GV (group undergoing balloon valvuloplasty): 44 patients (32.9 ± 9.5 years; 90.9% females). The patients' assessment comprised the following items: functional class, occurrence of events, electrocardiograph, and Doppler echocardiography. Results: A significant improvement in functional class occurred in most patients. Three patients in GC and in GV were in functional class III in P060M. No difference in the mitral gradient was observed between the groups. A difference in the mean mitral valve areas was observed between the groups during the entire evaluation. No patients died. In regard to the IPO of GC, 3 patients had moderate mitral insufficiency (Ml), and 3 had bleeding (1 was reoperated upon). In the IPO of GV, 4 patients had moderate Ml, 1 had severe Ml, 2 had cardiac tamponade, and 1 patient required surgery due to severe Ml. Over 60 months, 9 GV patients evolved to moderate or severe Ml, while 6 GC patients evolved to moderate or severe Ml, and 2 other GC patients required surgery due to double mitral dysfunction. Conclusion: The rate of success in open mitral commissurotomy and balloon mitral valvuloplasty was 100%, and the rate of complications was low. During follow-up, a mild elevation in mitral gradient and a drop in mitral valve area were observed in both groups.