[Percutaneous mitral valvuloplasty and open mitral commissurotomy: comparison of 2 techniques in immediate results]. / Valvuloplastía mitral percutánea y comisurotomía mitral abierta: comparación de las dos técnicas en los resultados inmediatos.

The aim of this study was to assess the real usefulness of percutaneous mitral balloon valvuloplasty (PMV). Eighty patients aged less than 56 years old, with symptomatic pure mitral stenosis, with an hemodynamic and echocardiographic area < 1.5 cm2, without associated valvular or coronary lesions and without surgical contraindications were studied. These were randomized in two groups of similar age, sex, symptomatology, cardiac rhythm, severity of stenosis and valve anatomy, that were subjected to PMV (n = 38) using a double balloon technique or to mitral commissurotomy (n = 42) with extracorporeal circulation (MC). Mitral areas (calculated using modified Gorlin's formula) increased in 1.15 +/- 0.28 and 1.72 +/- 0.34 cm2 in patients subjected to PMV and MC respectively. No patient died, there was one technical failure with PMV and two patients subjected to MC had a surgical wound infection. Mitral regurgitation increased in more than one degree in two patients treated with PMV (5%) and in 6 patients treated with MC (15%). It is concluded that PMV and MC are highly effective and safe procedures for the treatment of mitral stenosis. Mitral areas obtained with MC are higher than with PMV, however a significant improvement of the disease is achieved with both procedures and MC produces mitral regurgitation with a higher frequency.

[Percutaneous mitral valvuloplasty: immediate and late results in 300 patients]. / Valvuloplastía mitral percutánea: resultados inmediatos y tardíos en 300 pacientes.

Between December 1987 and July 1992, we performed a balloon mitral valvuloplasty to 300 patients aged 48 +/- 23 years, with pure or predominant, symptomatic mitral stenosis, with an hemodynamic area < 1.5 cm2 and a mean echocardiographic score of 8.8 +/- 1.3 (6-13). Young subjects with mobile and flexible valves as well as elders with highly damaged valves were included. A transeptal technique employing 2 balloons was used in 97% of cases. There were 3 failures and 9 deficient results. In 284 patients, the procedure was considered successful with a mean increase in mitral area (measured using modified Gorlin's formula) from 0.88 +/- 0.13 to 2.19 +/- 0.38 cm2. Four patients died two due to a left ventricular traumatism, one due to an irreversible low cardiac output and one due to a massive systemic embolism. In five, a cardiac tamponade was treated with pericardiocentesis or surgery. One hundred patients were followed for a mean of 40 +/- 3 months. Mitral areas remained over 1.5 cm2 in 87% and 14 had a significant reestenosis. The latter had an initial echocardiographic score over 8 or previous surgical commissurotomy. Multifactorial analysis identified valvular motility and global echocardiographic scores as predictors of immediate success. Likewise, the last parameter and subvalvular thickening were predictors of late reestenosis and of increase in mitral regurgitation post valvuloplasty. According to our experience, percutaneous balloon mitral valvuloplasty is a first choice therapeutic alternative in patients with mitral stenosis.

[Percutaneous aortic valvuloplasty in the adult: immediate results and follow-up of 43 patients]. / Valvuloplastía aórtica percutánea en el adulto: resultados inmediatos y seguimiento en 43 pacientes.

From June 1986 to June 1991, percutaneous balloon valvuloplasty was performed in 43 patients with severe symptomatic aortic stenosis. Their age ranged from 52 to 81 years (mean 69). The retrograde approach was used in 34 and the transseptal technique in the remaining 9. One patient died from severe tamponade, another developed a large cerebral infarct and the procedure failed in a third. The procedure was considered successful in the remaining 36 patients. Cardiac output increased from 3.5 +/- 0.6 to 4.7 +/- 0.7 l/min, (p < 0.01) and aortic valve area from 0.53 +/- 0.21 to 0.97 +/- 0.2 cm2 (p < 0.01). After a follow up period of 24 +/- 9 months 3 patients, all with initially poor results, died. 10 of 19 patients with adequate initial results experimented a deterioration of functional class. The other 9 patients have preserved the initial improvement obtained with dilatation. Thus percutaneous aortic valve dilatation in adults with severe aortic stenosis is risky and of limited clinical value.

[Percutaneous mitral valvuloplasty as a treatment of choice for mitral stenosis. Immediate results and long-term follow-up]. / Valvuloplastía mitral percutánea como tratamiento de elección de la estenosis mitral. Resultados inmediatos y seguimiento alejado.

We evaluated 77 patients with symptomatic mitral stenosis for balloon valvuloplasty. Five patients were excluded from the procedure due to the presence of intra-atrial thrombi or mitral valve endocarditis as detected by 2D echocardiography. The mean age of the 72 treated patients was 38 +/- 11 years, 68 were NYHA functional class II or IV: only 6 patients had valvular calcification. Three patients had severe liver failure, 2 were chronic alcoholics, one had liver cirrhosis, 2 had severe weight loss and 13 had pulmonary hypertension at systemic levels. 69 patients had a technically adequate procedure, one patient died, 1 developed cardiac tamponade and 1 failed. Mitral valve area increased from 0.93 +/- 0.34 to 2.38 +/- 0.67 cm2. Mitral incompetence increased in only 16 patients. After a mean follow up period of 15 +/- 5 months (range 8 to 27), 56 patients remained in FC I or II. Mitral valve area remained satisfactory in 54 patients. Mitral valve anatomy evaluated by echocardiography is helpful to predict immediate and late outcome. We conclude that balloon mitral valvuloplasty is the first choice for patients with severe symptomatic mitral stenosis.

[Percutaneous mitral valvuloplasty in 6 patients]. / Valvuloplastía mitral percutanea en 6 pacientes.

We performed a percutaneous mitral balloon valvuloplasty in 6 patients with severe mitral stenosis, aged 21 to 50 years. The mitral valve gradient decreased from 14.7 +/- 4.9 to 6.3 +/- 4.0 mmHg, p = 0.03. Mitral valve area increased in 5 patients (0.92 +/- 0.23 to 2.32 +/- 0.26 cm2, p = 0.04). One patient developed a transient cerebral ischemic attack without sequelae and mild mitral insufficiency. The diameter of the mitral annulus as measured by echocardiography was 48.5 +/- 8.1 mm, significantly larger than that reported in other series. The curvature of the transseptal needle was selected after an echocardiographic view of the inferior vena cava and atria from the subcostal window. This allowed a successful procedure in all patients regardless of cavity size.

Amiodarona oral y conversion a ritmo sinusal de la fibrilacion auricular cronica. / Chronic atrial fibrillation converted to sinus rhythm with oral amiodarone

Se administro amioradona oral, por un plazo maximo de 28 dias, a 20 pacientes con fibrilacion auricular cronica (FAC). En 7 casos (35%), se obtuvo conversion a ritmo sinusal entre los 14 y 21 dias de tratamiento. Hubo una mayor probabilidad de lograr la conversion en aquellos pacientes con menor duracion de la arritmia y menor tamano de la auricula izquierda. Se concluye que la amiodarona oral, puede ser una buena prueba terapeutica en algunos pacientes con FAC