[Percutaneous valvuloplasty in the treatment of mitral stenosis: results in Geneva].

Percutaneous balloon valvotomy is a recognized form of treatment of mitral stenosis. In Geneva between 1986 and 1993, 62 procedures were attempted in 60 patients (87% females) aged 48 +/- 17 years (12 to 80 years). Patient selection was based on symptoms (NYHA class), echocardiography (valve area, Boston score), and hemodynamics. 11 patients (18%) had undergone surgical commissurotomy in the past, 28 patients (47%) were in atrial fibrillation, and 12 patients (30%) had a history of peripheral emboli. Mild or moderate mitral insufficiency was present angiographically in 17 patients (28%) and echographically in 42 patients (70%). Esophageal echocardiography was performed in 37 patients (62%) before the procedure. In 52 patients (84%) a single balloon (Inoue technique) was used. Technical success was obtained in 59 procedures (95%). Following the procedure, mitral valve area increased from 1.1 +/- 0.3 to 1.8 +/- 0.3 cm2 (p < 0.0001) at echocardiography and from 1.1 +/- 0.3 to 1.9 +/- 0.5 cm2 (p < 0.0001) based on invasive hemodynamic data. There were 5 complications directly related to the procedure. In two cases cardiac tamponade developed, one after pericardial perforation during the transseptal approach and one because of left ventricular perforation. The second patient required surgical treatment. In two other cases, a moderate pericardial effusion without clinical consequences was observed. In one case the venous sheath malfunctioned, rendering surgical repair of the right femoral vein necessary. A residual atrial septal defect was observed at echography in 13 patients (22%). Mitral insufficiency was increased in 6 patients (10%) angiographically and in 9 patients (15%) at echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)