[Interest of percutaneous transvenous mitral commissurotomy in the management of rheumatic mitral stenosis].

During from April 1987 to October 1988, 13 cases of mitral stenosis (MS) were treated with percutaneous transvenous mitral commissurotomy (PTMC) among 24 cases of MS. The indications of PTMC were determined by surgeons in 4 cases with several reasons described as follows: 1. Patient, having been treated with closed mitral commissurotomy, who refused to be operated with open heart technique. 2. Patient associated with early gastric cancer. 3. Patient associated with severe hyperthyroidism and cardiac cachexia. 4. Patients suffering from acute renal failure following left heart failure due to association of aortic stenosis. Other 9 cases were determined by cardiologist because of the inherent benefit of PTMC being less invasive. After PTMC, the symptomatic improvement, assessed by means of NYHA classification, were observed in 11 cases out of 13. Hemodynamic data such as mitral valvular area, mitral valve gradient and cardiac index showed marked improvement without any inducing of significant mitral regurgitation. The authors thought with these results as follows: 1. The effect of PTMC may be appreciable for mild or moderate stenotic lesion of mitral orifice, however, severely affected valves should be treated by open heart techniques in order to perform radical procedures. Otherwise, significant MR may occur by overloading of balloon size beyond some extent. 2. On account of the appearance of PTMC, the indicational determination for the treatment of MS will be more controvertial than now.