Redo percutaneous mitral valvuloplasty for mitral restenosis: a comparison with first procedure for de novo mitral stenosis.

Background: Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in most patients with symptomatic mitral stenosis. However, very few reports have looked at redo PMV in patients with mitral restenosis.

Aim: In a retrospective study, we explored the immediate results of redo PMV compared to primary PMV.

Methods: We included 30 consecutive patients with de novo mitral stenosis and 40 consecutive patients with mitral restenosis after successful initial PMV. Echocardiographic assessment of the mitral valve was performed in all patients by transthoracic echocardiography (TTE), and trans-esophageal echocardiography excluded left atrial thrombosis. Percutaneous mitral valvuloplasty was performed by the antegrade trans-septal approach using either the standard Inoue technique or the multitrack technique. Patient assessment by TTE was repeated 48 hours after the procedure. Procedural success was defined as a 50% or more increase in mitral valve area, with a final mitral valve area ≥ 1.5 cm(2), without major complications.

Results: The mean age of the study population was 33.7 ± 6 years, 18 (25.7%) patients being male. Procedural success was achieved in 28 (93.3%) patients undergoing first PMV, and in 37 (92.5%) patients undergoing redo PMV (NS). The two groups were similar in terms of the final mitral valve area, the gain of mitral valve area, the mean pressure gradient across the mitral valve, and the complication rate (NS for all). The final mitral valve area correlated negatively with the baseline mitral valve score in both groups.

Conclusions: Redo PMV for mitral restenosis achieves immediate results that are comparable to initial PMV for de novo mitral stenosis.