OBJECTIVEPercutaneous mitral valvuloplasty has been shown to be an acceptable alternative to surgery as treatment for selected patients with severe mitral stenosis. We examined hemodynamic, echocardiographic, and pathomorphologic findings in a series of 308 patients undergoing balloon valvuloplasty, 41 of whom underwent subsequent surgery, in search of possible predictors of an unsuccessful outcome.INTERVENTION AND RESULTSPatients with severe mitral stenosis underwent Inoue single ballon valvuloplasty over a 48-month period and had follow-up for a mean of 14.5+/-16.8 months (range 1 to 64 months). Of the 308 patients, 267 (Group I) were clinically improved and stable throughout follow-up, while subsequent surgery was required in 41 (Group II) after 38.2+/-143.5 days (range 1 to 1212). Significant differences between the groups were observed for NYHA class (2.7+/-0.6 vs 2.9+/-0.6, p<0.05), mitral valve area (1.0+/-0.3 vs 0.9+/-0.2 cm2, p<0.01) and left atrial endsystolic dimension by echo (51.3+/-8.0 vs 55.4+/-10.2 mm, p<0.01). Two of the 41 Group II patients underwent surgery for left to right shunting, 1 for tamponade and 2 were lost to follow-up. The excised mitral valves of the remaining 36 patients all showed calcification and/or fibrosis: 9 homogenous, 5 non-homogenous; 19 were classified as having a funnel-shaped deformity, and 3 did not fit into a discrete category. Among the funnel-shaped valves, 13 had a tear versus 6 where dilation was primarily accomplished by stretching. Only one of 9 valves with homogenous calcification was torn, whereas a tear was noted in 3 of the 5 with non-homogenous calcification.CONCLUSIONFunnel-shaped valves and those with non-homogenous distribution of calcification and/or fibrosis appear to be least suitable for balloon valvuloplasty.

Percutaneous balloon mitral valvulotomy (PBMV) with the Inoue-balloon is a proven therapy in young patients with mitral stenosis. In this study, we investigated primary results in PBMV of elderly patients. In 383 patients with mitral stenosis PBMV was done with the Inoue-balloon. We compared primary success rates and short-term follow-up of 287 (74.9%) < 65-year-old patients and 96 (26.1%) > or = 65-year-old patients. Elderly patients were more likely to have atrial fibrillation (58% vs. 45%; p < 0.05), tricuspid regurgitation < or = II degrees (58% vs. 45%; p < 0.05), coronary artery disease (16% vs. 6%; p < 0.01), and previous pulmonary edema (42% vs. 30%; p < 0.05). PBMV was successful in 73.9% of the elderly and 84.7% of the younger patients (p < 0.05). Mitral valve gradients could be reduced from 12.5 +/- 11.6 mm Hg to 6.2 +/- 6.8 mmHg (p < 0.001) in elderly patients and from 15.5 +/- 6.9 mm Hg to 7.0 +/- 3.2 mm Hg (p < 0.001) in younger patients. Mitral valve areas increased from 1.0 +/- 0.3 cm2 to 1.6 +/- 0.5 cm2 (p < 0.001) in elderly patients and from 1.0 +/- 0.3 cm2 to 1.7 +/- 0.4 cm2 (p < 0.001) in younger patients. No patient died during the procedure. Two younger patients had emergency surgery because of pericardial tamponade following transseptal puncture. After PBMV elderly patients had more often an increase of mitral regurgitation (47% vs. 35%; p < 0.05) without need of an emergency mitral valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous balloon mitral valvulotomy (PBMV) with the Inoue-balloon is a proven therapy in young patients with mitral stenosis. In this study, we investigated primary re suits in PBMV of elderly patients. In 383 patients with mitral stenosis PBMV was done with the Inoue-balloon. We compared primary success rates and short-term follow-up of 287 (74.9%) < 65-year-old patients and 96 (26.1%) greater than or equal to 65-year-old patients. Elderly patients were more likely to have atrial fibrillation (58% vs. 45%; p < 0.05), tricuspid regurgitation less than or equal to II degrees (58% vs. 45%; p < 0.05), coronary artery dis ease (16% vs. 6%; p < 0.01), and previous pulmonary edema (42% vs. 30%; p < 0.05). PBMV was successful in 73.9% of the elderly and 84.7% of the younger patients (p < 0.05). Mitral valve gradients could be reduced from 12.5 +/- 11.6 mm Hg to 6.2 +/- 6.8 mm Hg (p < 0.001) in elderly patients and from 15.5 +/- 6.9 mm Hg to 7.0 +/- 3.2 mm Hg (P < 0.001) in younger patients. Mitral valve areas increased from 1.0 +/- 0.3 cm(2) to 1.6 +/- 0.5 cm(2) (p < 0.001) in elderly patients and from 1.0 +/- 0.3 cm(2) to 1.7 +/- 0.4 cm(2) (p < 0.001) in younger patients. No patient died during the procedure. Two younger patients had emergency surgery because of pericardial tamponade following transseptal puncture. After PBMV elderly patients had more often an increase of mitral regurgitation (47% vs. 35%; p < 0.05) without need of an emergency mitral valve replacement. During 3-month follow-up 6 elderly (6.3%) as well as 6 younger (2.1%) patients underwent elective mitral valve replacement (p < 0.05). According to the NYHA classification elderly patients had more complaints (1.9 +/- 0.8) than younger patients (1.6 +/- 0.6) (p < 0.001). In conclusion, PBMV with the Inoue-balloon is an efficient therapy in elderly patients, too. Compared to younger patients primary success rate was reduced and incidence of mitral regurgitation was increased, probably because of the more severe changes of valvular and subvalvular morphology. Therefore, elderly patients more often underwent elective mitral valve replacement during short-term follow-up.