Balloon mitral valvuloplasty: clinical experience at the Texas Heart Institute.

For treatment of symptomatic mitral valve stenosis, balloon valvuloplasty has emerged as an alternative to surgery. This report describes our initial clinical experience with balloon mitral valvuloplasty in 45 patients (37 women and 8 men; age range, 34 to 79 years) treated from December 1986 through March 1991. Thirty-nine of the 45 patients (87%) underwent a complete procedure (that is, they had at least 1 balloon inflation and did not require emergency surgery). Pre- and post-procedural catheterization showed that these patients had a significant improvement in mean mitral valve area, from 1.0 +/- 0.3 cm(2) to 1.9+/-0.8 cm(2). Catheterization data revealed a decrease in transmitral gradient, from 16.3 +/- 7.6 mmHg to 7.6 +/- 3.7 mmHg, and an increase in cardiac index, from 2.5 +/- 0.7 L/min/m(2) to 2.9 +/- 0.8 L/min/m(2). These improvements were all statistically significant (p <0.0005). A clinically successful balloon mitral valvuloplasty was defined as an uncomplicated procedure yielding either a final mitral valve area > 1.5 cm(2) or a 40% increase in mitral valve area, and an immediate post-valvuloplasty mitral regurgitation grade </=3+. Thirty-two of the 45 patients (71%) were considered to have had a successful procedure. Another 7 patients underwent subsequent mitral valve replacement due to either a suboptimal final mitral valve area (3 patients) or >2+ increase in mitral regurgitation (4 patients). In 6 patients, the procedure was considered incomplete because of technical failure or complications. Two of these patients had nonfatal cardiac tamponade, and 1 had a torn mitral annulus that resulted in severe mitral regurgitation requiring emergent mitral valve replacement. In another patient, we were unable to cross the mitral valve with a 2nd valvuloplasty balloon after the 1st one proved unsatisfactory. There were 2 in-hospital deaths, only 1 of which was related to the procedure. Over time, our success rate has improved from 60% in the 1st 20 patients to 80% in the subsequent 25 patients, reflecting a learning curve. In particular, we attribute this improvement to increased operator experience, refinements in balloon technology, and, in more recent procedures, the initial use of smaller balloons. The improvement also reflects a change in demographic pattern, characterized by recent application of the procedure to younger patients with fewer concomitant illnesses. Because long-term follow-up data are available for only 23 patients, we cannot comment on the long-term efficacy of this technique. Overall, however, our short-term experience indicates that balloon mitral valvuloplasty is a safe, effective alternative for treating symptomatic mitral valve stenosis in carefully selected adults.