[Percutaneous mitral commissurotomy: how can it be made simpler and more efficacious?]. / La commissurotomie mitrale percutanée: comment faire plus simple et plus efficace?

The authors report the results of a simplified method of percutaneous mitral dilatation from 936 procedures. This method introduced in our service since 1997 consists in progressively increasing diameters inflation of Inoué balloon, using echographic control and without any arterial procedure. Our population consists on 683 women (73%) and 253 men with a mean age 34 +/- 15 years (extremely 9 and 80 years) with subgroups composed of 26 pregnant women, 32 children less than 17 years, 59 restenosis after closed heart mitral commissurotomy, 14 restenosis after open heart mitral commissurotomy, 74 restenosis after percutaneous mitral commissurotomy, 5 tricuspid and mitral dilatation, 2 coronary and mitral dilatation (with stenting), 2 patients with a history of surgical mitral valvuloplasty for pure mitral regurgitation. The mitral area passed from 1 +/- 0.2 cm2 to 2.1 +/- 0.1 cm2. A surgical mitral regurgitation was observed in 3 cases. The time of fluoroscopy was 6.4 +/- 3.3 min. The hole time procedure was 19 +/- 9 min. The delay of hospitalisation was one day in 97% of patients. The decreased cost was about 20%. The patient comfort and the large diffusion of this method predicts a good future of this simplified technique.

[Evolution after 5 years of percutaneous pulmonary valvulotomy: report of 47 cases]. / Evolution a plus de 5 ans de la valvulotomie pulmonaire percutanée: a propos de 47 observations.

47 patients aged from 2 to 59 years affected by valvular congenital or mixed pulmonary stenosis including three fallot trilogies and one patient with right congestive cardiac failure are treated by percutaneous pulmonary valvulotomy between october 1986 and december 1990. All patients have been controlled with a mean follow-up of 6.5 +/- 1.1 years. The total gradient rate between pulmonary artery and right ventricule decrease from 112 +/- 55 mm Hg to 20 +/- 8 mm Hg on the last control with disappearance of infundibular inflammation and inter auricular shunt in all the concerned cases. We observe the regression of right cardiac failure symptoms with disappearance of tricuspid insufficiency in the cases of advanced pulmonary stenosis with right ventricular dysfunction. Percutaneous pulmonary valvulotomy by its simplicity and harmlessness, its long term efficiency is a good method of treatment of pure valvular or mixed pulmonary stenosis.

[Percutaneous mitral commissurotomy: simplified new method]. / La commissurotomie mitrale percutanée: nouvelle méthode simplifiée.

We report a new simplified method of mitral dilatation done on 146 patients. This technique use the Inoue balloon with progressive diameters under ultrasonographic control, avoiding the arterial part of the dilatation. The population include 9 pregnant women, 13 children, 13 with restenosis and closed heart and 12 restenosis after dilatation. Mean age is 32 +/- 16 years (9 to 72) and sex ratio 3.7 (114 F/32 M). Three groups are individualized according to histopathologic exam of mitral structure, group I (26%) concern good indication and III (32%) bad indication for this technique, group II (42%) contain intermediate indications. Commissurotomy increase the mean mitral square for 0.2 to 1.9 +/- 0.1 cm_. We observe 3 cases of chirurgical mitral insufficiency needing remplacement recruited for 2 patients from the group III. Mean fluoroscopic exposition time is 5.2 +/- 3.3 mn and procedure duration 18 +/- 11 mn. Hospitalisation duration is one day for 95% of the patients. This method remaining simple, efficient and safe permit a gain in time of 70% with a good comfort for patient and a return to work on the 4th day.

[Outcome more than 10 years later of mechanical mitral valve prostheses in children]. / Evolution au-delà de 10 ans des prothèses valvulaires mécaniques en position mitrale chez l'enfant.

Between 1966 and 1975, fifty-one children aged from 8 to 15 years underwent mitral valve replacement for mitral valve disease of rheumatismal origin. The mechanical prosthesis was a Starr Edwards 6120 N degrees 2 valve in 48 of the children. Late mortality was 20 p. 100; death was due to valve thrombosis in 3 cases, aortic valve regurgitation in 2 cases and left ventricular dysfunction in 2 cases; it was of unknown origin in 3 cases. Four patients were lost sight of, and 36 have survived up to now with a mean follow-up period of 13 years. The life of these 36 patients has been marked by three types of complication. The first complication was thromboembolic accidents which occurred in 10 patients, were virtually always isolated and regressed completely. The incidence of these accidents was highest in patients treated with antivitamin K irregularly. In 23 patients who did not receive antivitamin K the incidence was only 2.27 thromboembolic accidents per 100 patient-years. The second complication, which affected only 4 patients, was functional stenosis of the prosthesis; it developed very late and was always due to periannular fibrosis either isolated or associated with remodelling of the mitral valve left in situ. The third complication was the development, with or without patent rheumatismal activity, of a lesion of the aortic orifice which required reoperation in 5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)