Non-surgical mitral commissurotomy using metallic commissurotome.

Percutaneous transatrial mitral commissurotomy using a new miniaturised metallic commissurotome mounted on a 12 F catheter was done in 24 patients with severe mitral stenosis. There were 17 (70.8%) females and seven (29.2%) males with age ranging from 12-42 years (mean 26.0 +/- 6.7 years). Atrial fibrillation was present in three (12.5%) patients. Three (12.5%) patients had restenosis following closed mitral commissurotomy. The mitral valve score on echocardiography ranged from 6 to 10 (mean 7 +/- 1.3). The procedure was performed with one device which was reused after sterilisation with glutaraldehyde. The device was opened maximally upto 39.0 +/- 1.7 mm (range 35-40 mm). The procedure was successful in 23 (95.8%) patients. The mean left atrial pressure decreased from 26.8 +/- 8.0 to 9.3 +/- 7.1 mm Hg (p < 0.001). There was a fall of mean pulmonary artery pressure from 47.2 +/- 18.6 (range 20-29 mm Hg) to 23.6 +/- 9.6 mm Hg (range 12-51 mm Hg) (p < 0.001). The mitral valve area as assessed by Doppler echocardiography (pressure half time) increased from 0.9 +/- 0.1 (range 0.6-1.2 cm2) to 2.1 +/- 0.4 cm2 (range 1.6-2.6 cm2) (p < 0.001), with split in both commissures in 22 (95.6%) cases. One patient developed severe mitral regurgitation with tear in the anterior mitral leaflet needing immediate mitral valve replacement. One patient developed transient aphasia which recovered completely within four hours. Percutaneous transatrial mitral commissurotomy using metallic commissurotome offers reliable and effective alternative to balloon mitral commissurotomy and may be more cost-effective because of its reusability.