Comparison of immediate and mid-term results of mitral balloon valvotomy in children and adolescents with those in adults.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate and compare the hemodynamic benefits of mitral balloon valvotomy (MBV) in young (child/adolescent) and older (adult) patients with severe mitral stenosis. METHODS: The younger group comprised 61 patients (mean age 17 +/- 3 years), and the older group 264 patients (mean age 35 +/- 10 years). All patients underwent MBV using an Inoue balloon to treat symptomatic and severe mitral stenosis. The long-term follow up of both groups was monitored on a comparative basis. RESULTS: The success rate of MBV was similar in both groups (95% in younger patients, 96% in older patients) (p = 0.36). Mitral valve area (MVA) was increased from 0.8 +/- 0.2 to 2.0 +/- 0.3 cm2 in the younger group, and from 0.8 +/- 0.3 to 1.9 +/- 0.3 cm2 in the older group. The mean mitral valve gradient was decreased significantly both in the younger group (from 13 +/- 5 to 5 +/- 2 mmHg) and older group (from 12 +/- 5 to 5 +/- 3 mmHg) (p < 0.001). Both groups had similar MVA and mean gradient at baseline and follow up. At follow up (mean 37 +/- 27 months), MVA monitored by Doppler echocardiography remained at 1.7 +/- 0.4 and 1.6 +/- 0.4 cm2 (p = 0.08). Similarly, the mitral valve mean gradient remained stable (p = 0.92). Severe mitral regurgitation developed in one younger patient, and in seven older patients (p = 0.66). Two cases of tamponade occurred in each group, and one older patient suffered a transient stroke. There was no mortality in either group. CONCLUSION: In patients with rheumatic mitral stenosis, the outcome of MBV in children and adolescents was at least comparable with that in adults. In addition, the benefits were similar in each age group on completion of follow up.

Prosthetic valve thrombosis-case report and literature review.

Prosthetic valve thrombosis (PVT) is a dreaded complication of patients with mechanical valves, particularly those in the mitral position. The diagnosis is based on the clinical presentation, supported by echocardiography. As it provides a sustained benefit with low rates of embolization, thrombolyic therapy is a good non-invasive alternative to surgical therapy for carefully selected patients.

Effectiveness of stents in small coronary arteries.

This study was prospectively randomized to assess the efficacy and safety of Jo heparin-coated stent deployment in small vessels compared with balloon angioplasty. In 202 patients, restenosis in balloon and stent arms was 49% and 30%, respectively.

Immediate and midterm outcome of balloon mitral valvotomy in children and adolescents.

BACKGROUND: The midterm and long term results of balloon mitral valvotomy (BMV) have not been well characterized, particularly in those below the age of 20 years. AIM: The present study evaluated the hemodynamic benefits, safety and efficacy, as well as the midterm follow-up results, of Inoue BMV in children and adolescents less than 20 years of age who have severe mitral stenosis. PATIENTS: Sixty-one patients younger than 20 years of age underwent BMV between December 1989 and May 1998. METHODS: All patients underwent BMV using the Inoue balloon for symptomatic severe mitral stenosis with a mitral valve area less than 1.2 cm2. Cardiac hemodynamics were acquired before and immediately after BMV. In addition, Doppler echocardiography measurements were obtained during follow-up. RESULTS: The procedure was successful in 59 patients (96.7%). There were no deaths during the procedure or during follow-up. The mean Boston Mitral Echo score was 7.4 1.4. Mitral valve area on cardiac catheterization increased from 0.8 0.3 to 1.9 0.6 cm2 (P<0.001), and the mean mitral valve gradient decreased from 16.9 5 to 5.8 2.8 mmHg (P<0.001). Severe mitral regurgitation developed in one patient (1.6%) and cardiac tamponade developed in two. At a mean follow-up of 36.9 27 months (range 12 to 84 months), mitral valve area by Doppler echocardiography remained at 1.7 0.4 cm2 and the mean mitral valve gradient by Doppler echocardiography was 6 2 mmHg. CONCLUSIONS: BMV is safe and effective in children and adolescent patients with rheumatic mitral stenosis and provides a similar hemodynamic benefit with that reported in adults. The benefits were sustained during a mean follow-up period of 36 months.