الفهرس 
Mitral Valve ApparatusOnly 14 pages are availabe for public view
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Abstract
Background: Percutaneous balloon mitral valvotomy (PBMV) was introduced in 1984 by Inoue. Since then, PMBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis.With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. Restenosis after PMBV ranges from 4 to 70% depending on the patient selection, valve morphology, post procedure MVA, and duration of follow up. The feasibility of redo PBMV is not well known.
Aim of our study is to assess the immediate results of repeated percutaneous balloon mitral valvuloplasty in patients with mitral restenosis after previous successful PBMV.
Methods: Our study included 70 patients, whom were classified into two groups, 30 patients (group A) who underwent PBMV for the first time, and 40 patients (group B) who underwent PBMV as a redo procedure. All patients were subjected to full history taking, general and, local examination, resting, 12 leads ECG, echocardiographic examination before and one day after the procedure, and transesophageal echocardiography (TEE) 1-2 days before procedure. Multi-track double balloon and Inoue single balloon were used for PBMV.
Results: The immediate outcome of PBMV for patients who had restenosis were satisfactory, with a 92.5% success rate (group B) compared with 93.33% in patients who underwent PBMV as an initial procedure (group A), (p= NS). There was no difference as regard the changes in decreasing L.A.Pr, MMG, and RVSP after PBMV, but only small difference was observed as regard the increase in post PBMV-MVA in favor of group A, where MVA increased from 1.2±1.1 to 1.92±0.4 cm2 in group A, and from 1.03±0.13 to 1.7±0.3 cm2 in group B (p= 0.016).NO significant difference as regard the incidence of serious complications were noted between two groups. Factors which determine freedom from redo PBMV or restenosis were: Rhythm (in favor of SR, P=0.009), post procedure increment in MVA (p=0.004), low echo score (p=0.008), and long acting penicillin (in favor of patients receiving LAP, p=0.007).
Conclusion: We concluded that, PBMV should be considered the first option in patients who have restenosis. Prescription of LAP is advisable for patients undergoing PBMV either as a first or a redo procedure.