[Percutaneous mitral commissurotomy with Inoue's technic and pregnancy. The initial experience in Mexico]. / Comisurotomía mitral percutánea con técnica de Inoue y embarazo. Experiencia inicial en México.

From March 1986 to January 1993, we performed percutaneous balloon mitral commissurotomy (PBMC) in ninety-one patients with rheumatic mitral stenosis, two of them during pregnancy. The gestational age at the time of valvotomy was thirty and twenty-seven weeks respectively. Balloon Inoue technique in both cases resulted in improvement in mitral valve area (0.8 vs 1.6 and 0.7 vs 1.9 cm2) and in mean mitral gradient (19 vs 4 and 12 vs 0 mm Hg) immediately after dilation, without residual atrial septal defect or mitral insufficiency. There were no complications. The estimated radiation exposure to the fetus was of 6.4 minutes of fluoroscopy and 6 seconds of angiography. To limit of X-ray irradiation, we used color Doppler echocardiography during dilatation in both cases. The subsequent course of gestation was uncomplicated and normal babies were delivered in both cases. Fetus protection against ionising radiation was assured by lead mantles. In the follow-up the mitral valve area was 1.7 and 2.1 cm2, 15 and 4 months later respectively. PBMC can be performed safely during pregnancy and is effective in increasing the valvular area and relieving symptoms. It offers an excellent alternative for the pregnant patients, with severe mitral stenosis. The risk to the fetus appears lower than previous reports of surgical commissurotomy performed during pregnancy.

[Coronary angioplasty as the treatment in different myocardial ischemic syndromes: a report of 121 consecutive cases]. / Angioplastía coronaria como tratamiento de diversos síndromes de isquemia miocárdica: informe de 121 casos consecutivos.

In 121 patients (93 males, mean age 53.9 years), percutaneous transluminal coronary angioplasty (PTCA) of 140 lesions was performed as treatment of symptomatic, single or multiple vessel disease, with the following clinical syndromes: stable angina pectoris (Group I) in 59 cases (48.8%), unstable angina (Group II) in 40 (33%), and angina or residual ischemia after thrombolysis for myocardial infarction (MI) (Group III) in 22 patients (18.2%). PTCA was successfully accomplished in 123 of 140 segments (87.8%), with a reduction in mean luminal stenosis from 87.3 +/- 13% (range 70-100) to 15 +/- 10% (range 0-30, p less than 0.00001). Successful results were obtained in 85.9% of patients (104/121) and they were 84.7%, 82.5% and 95.5% in Groups I, II and III, respectively. The procedure failed in 17 cases (14.0%), and within this group, 14 complications occurred (11.6%): 2 deaths (1.6%), 3 cases of MI, acute closure in 4, and emergency coronary bypass surgery in 5 patients. Late evaluation (6-8 months) revealed clinical and functional improvement in 71/98 patients (72.4%), and recurrent ischemic symptoms (no improvement) in 27 cases. Coronary angiography performed in 20, showed restenosis in 10, and progressive disease in 7 patients. In conclusion, PTCA is an effective therapeutic option in selected cases of symptomatic ischemic heart disease with suboptimal results to medical management alone.

[Percutaneous transvenous mitral commissurotomy with the Inoue catheter: the initial experience in Mexico]. / Comisurotomía mitral transvenosa percutánea con el catéter de Inoue: experiencia inicial en México.

Percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter (IBC) was performed in 11 adult, symptomatic patients with moderately severe, pure of predominant mitral stenosis (MS). The transseptal approach and a valvuloplasty technique of progressive and controlled valvular dilatation were utilized. The procedure failed in one patient due to an inadequate transseptal puncture, and it was successful in the other 10. The mitral valve area increased from 1.00 +/- 0.27 to 2.19 +/- 0.31 cm2 (p less than 0.001); the diastolic mitral gradient decreased from 20.9 +/- 4.6 to 5.9 +/- 3.3 mmHg (p less than 0.001); similar reduction was obtained in the mean atrial pressure from 22.3 +/- 5.8 to 11.6 +/- 4.2 mmHg (p less than 0.001), and the mean pulmonary arterial pressure from 41.3 +/- 16.1 to 26.4 +/- 10.5 mmHg (p less than 0.05). There were no complications. Left to right shunting at the atrial level, due to the transseptal approach, was moderately significant in only 2 patients (QP/QS = 1.4 and 1.3 respectively). Grade I, and grade I-II mitral insufficiency occurred in 2 patients, one of them with previous mitral regurgitation, and it was not demonstrated or disappeared (if preexistent) in the rest. Patients were discharged in 48 hs at the most. They all referred improvement in their functional class, and at 4.3 months of average follow-up they are asymptomatic. In conclusion, PTMC with the IBC is a safe, simple and successful technique to separate the fused commissures, increase the mitral valve area and improve the functional class in selected cases of rheumatic MS. A long term follow-up is required for evaluation of late results.