Long-Term Clinical and Echocardiographic Outcome in Patients With Mitral Stenosis Treated With Percutaneous Transvenous Mitral Commissurotomy

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Long-term follow-up after percutaneous transvenous mitral commissurotomy(PTMC)is limited. Ninety-four middle-aged(51±9 years)mitral stenosis patients who underwent successful PTMC were followed up with annual echocardigraphy for 6.1±1.4 years. PTMC success was defined as either mitral valve area(MVA)>1.5 cm^2 or a MVA of more than twice the pre-procedural value, together with no worsening of mitral regurgitation>grade 2+. Mitral valve replacement(MVR), worsening of congestive heart failure(CHF), and thromboembolism were sought for survival analysis. Restenosis was defined as loss of more than 50% of the initial procedural MVA gain. Functional limit of daily activities was assessed through a questionnaire. The study population was divided into group 1(post-procedural MVA>2.0cm^2), group 2(MVA>1.5cm^2 and ≤2.0cm^2)and group 3(MVA≤1.5cm^2). The 6-year survival with freedom from MVR, CHF, thromboembolism, and combined events(MVR+CHF)was 92%, 95%, 91%, and 88%, respectively. No group 1 patient experienced MVR or CHF. Restenosis was predominant in group 3. Deterioration of daily activities during follow-up was not observed in group 1; however, it was significant in group 2(p<0.05)and group 3(p<0.001). These results demonstrated that patients who attained a large MVA(>2.0cm^2)immediately after PTMC maintained their procedural benefit with less clinical complication and with less limitation of daily activity.

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