[Clinical reassessment of open mitral commissurotomy as a treatment for mitral valve stenosis: a comparative study with percutaneous transvenous mitral commissurotomy].

Recently, percutaneous transvenous mitral commissurotomy (PTMC) was applied as a treatment for mitral valve stenosis (MS) and patients who received PTMC are increasing. The objective of this study is to establish therapeutic strategy for MS by comparing the indication and clinical results of open mitral commissurotomy (OMC: n = 95) and PTMC (n = 54). Both groups showed almost equivalent preoperative data in echocardiographic score and cardiac catheterization, and postoperatively, they obtained almost same results. But when the author defined that successful commissurotomy is to gain the following postoperative cardiac catheterization data: mitral valve gradient < 10 mmHg, mitral valve area (MVA) > or = 1.3 cm2, mitral regurgitation < or = Sellers II/IV, success rate was higher in OMC group up (72%) than PTMC group (63%). There was no difference between OMC group and PTMC group in the early mortality and late survival. But reoperation free rate at the four postoperative year was higher in OMC group (100%) than PTMC group (94.5%). We found that the factors of unsuccessful PTMC were 1) MVA < 0.8 cm2, 2) total echo score > or = 8 and 3) subvalvar thickening score > or = 3 in the preoperative data. We conclude that PTMC can be applied for MS with mild subvalvar lesion (subvalvar thickening score < or = 2) and OMC is superior to PTMC for releasing subvalvar stenosis than PTMC. However, mitral valve replacement might be a procedure of choice for MS with severe subvalvar lesion (subvalvar thickening score 4).