[Balloon valvuloplasty in mitral stenosis. Hemodynamic results, influencing factors and comparison with surgical procedures].

Percutaneous transluminal valvuloplasty for mitral stenosis represents an alternative to surgical treatment. The reported increases in valve orifice area vary with values from 0.6 to 2.03 cm2 over a wide range. This study was undertaken to evaluate our own results and to determine if factors could be identified which may exert an influence on the outcome of the procedure. Additionally, to evaluate this new method of treatment, the pressure-flow relationship at rest and during exercise after valvuloplasty was compared with that observed after mitral valve commissurotomy or mitral valve replacement. In 25 patients with moderately-severe to severe mitral stenosis, mean age 56 +/- 11 years, mean valve orifice area 1.1 +/- 0.37 cm2, 52% with preexistent regurgitation, antegrade percutaneous, transvalvular valvuloplasty was carried out. Diagnostic catheterization was performed immediately prior to and after the procedure. Two concurrent groups of patients were analyzed for the purpose of comparison: 26 consecutive patients who underwent mitral valve commissurotomy with a comparable valve orifice area of 1.13 +/- 0.39 cm2 of whom 31% had a regurgitant component; and 37 consecutive patients who had valve replacement mostly with a Björk-Shiley prosthesis (M 29, 31, 33), mean age 52 +/- 8 years, comparable valve orifice area of 1.1 +/- 0.37 cm2 and a regurgitant component in 65%. Dilatation of the valve was carried out after transseptal catheterization with the use of an 8F Mullins sheath introducing a 7F balloon-tipped catheter (Critikon) via the left atrium, the left ventricle and into the descending aorta through which a 300 cm long 0.035" guidewire was advanced. By means of a retrieval catheter introduced via the femoral artery into the descending aorta, the guidewire was exteriorated via the femoral artery. After dilatation of the septum with a 9F dilatation catheter with a balloon of 8 mm diameter, a 10F or 12F dilatation catheter (Trefoil 3 X 12 mm or Bifoil 2 X 19 mm) (Schneider-Shiley) was advanced transseptally and the balloons positioned at the level of the mitral valve. The balloons were inflated with a pressure averaging 3.6 + 0.65 atmospheres (2-4.7 atm) and a mean duration of 27 +/- 8 s (16 to 45 s) on the average 3.9 +/- 1.6 times (1 to 9X) until disappearance or widening of the hour-glass waist of the balloon.(ABSTRACT TRUNCATED AT 400 WORDS)