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Balloon Mitral Valvuloplasty Effectively Relieves Severe Congenital Mitral Stenosis 

August 3, 2005

By Sahar Bedrood B.S. and Asher Kimchi M.D.

Boston, MA- Congenital mitral stenosis (MS) is a rare condition that is often associated with left heart obstructions. Treatments for MS include balloon mitral valvuloplasty (BMVP), surgical mitral valvuloplasty (SMVP) and mitral valve replacement (MVR). A study by Dr. Doff McElhinney et al from Harvard Medical School compared the outcomes of patients with severe congenital MS who underwent BMVP or surgical intervention. The study, which was published in the August 2, 2005 issue of Circulation found BMVP effectively relieves left ventricular inflow obstruction in the majority of cases and is the preferred mode of treatment in most infants with severe congenital MS. 

Between 1985 and 2003, 108 patients with severe congenital MS underwent BMVP or surgical intervention at a median age of 18 months (range 1 month to 17.9 years). Anatomic subtypes of MS were "typical" congenital MS in 78 patients, supravalvar mitral ring in 46, parachute mitral valve in 28, and double-orifice mitral valve in 11, with multiple types in

50% of patients. Additional left heart anomalies were present in 82 patients (76%). The first MS intervention was BMVP in 64 patients, SMVP in 33, and MVR in 11. BMVP decreased peak and mean MS gradients by a median of 33% and 38%, respectively (P<0.001), but was complicated by significant mitral regurgitation in 28%. Cross-sectional follow-up was obtained at 4.84.2 years. Overall, Kaplan-Meier survival was 92% at 1 month, 84% at 1 year, and 77% at 5 years, with 69% 5-year survival during the first decade of our experience and 87% since (P=0.09). Initial MVR and younger age were associated with worse survival. Survival free from failure of biventricular repair or mitral valve reintervention was 55% at 1 year among patients who underwent BMVP and 69% among patients who underwent supravalvar mitral ring resection initially. Among patients who underwent BMVP, survival free from failure of biventricular repair or MVR was 79% at 1 month and 55% at 5 years, with worse outcome in younger patients and those who developed significant post-dilation mitral regurgitation. 

The goal of BMVP for children with congenital MS is to reduce left ventricular inflow obstruction and left atrial pressure, thereby relieving symptoms and delaying MVR until the patient is older.  

Overall, the procedural mortality of BMVP is uncommon and is an effective means of relieving left ventricular obstruction in congenital MS. However, surgical resection is preferable in patients with MS due to a supravalvar mitral ring.  

Co-authors: Doff B. McElhinney, MD; Megan C. Sherwood, MBBS, FRACP; John F. Keane, MD; Pedro J. del Nido, MD; Christopher S.D. Almond, MD, MPH; James E. Lock, MD . 


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