P813Percutaneous mitral commisurotomy in patients with unfavourable mitral valve morphology

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Background: The effect of mitral valve morphology (MVM) on the immediate and long-term results of Percutaneous mitral commisurotomy (PMC) is not well characterized.Objectives: The purposes of this study were to:Evaluate the immediate and long-term results of PMC in patients with unfavourable MVM (echocardiographic score >8).Compare these results with the ones obtained in patients with favorable MVM.Materials and methods: Our study is retrospective enrolling 354 patients, hospitalized in the cardiology department between January 1996 and January 2011 who benefited from a PMC. Clinical and echocardiographic follow-up was more than 10 years.Patients were divided accordingly to their Wilkins echo score before PMC into group A with unfavorable MVM (echo-score > 8) and group B with favorable MVM (echo-score < 8).Results: - 87 patients were with unfavourable MVM (24,6 %), 78 % were woman. The mean age was 33.8+-14.81 years. 40 % were in atrial fibrillation. The mean mitral area (MMA) passed from 0.93 +-0.18 cm2 to 1.69 +-0.39 cm2 after PMC (p :0.015). The transmitral gradient passed from 19.29 +-10.74 mmhg to 8.24+- 4.35 after PMC (p= 0.021) and. the mean pulmonary artery pressure passed from 52.84 +-19.85 mmhg to 39.78+-16.06 mmhg (p= 0.032). Severe mitral regurgitation following mitral balloon valvuloplasty was noted in 5 patients and tomponnade was revealed in 3 cases. At a mean follow-up of 60 ± 35.4 months, 28 patients (32 %) required mitral valve replacement or a second valvotomy. The restenosis was defined in our study by a mitral surface low than 1,5cm2, it was noted in 35 patients that is 40 %-The Comparison between the both groups showed that in the (groupB) 19 % patients were in atrial fibrillation however in the (groupA) AF was noted in 40 % (P=0.001). In our study there were significantly more complications following mitral balloon valvuloplasty in the (groupA) compared with (groupB). Finaly Restenosis occurred significantly more frequent in 40 % in group A vs 30 % in group B (P 0.007).Conclusion: PMC in patients with unfavourable MVM has a satisfactory technical success rate and a good immediate hemodynamic result but a high cardiovascular event rate and restenosis in follow-up.

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