Why the study?
Although immediate success of percutaneous mitral commissurotomy for rheumatic mitral stenosis is well documented, long-term durability and predictors of restenosis required evaluation.
Does percutaneous mitral commissurotomy provide long-term efficacy and prevent restenosis in patients with rheumatic mitral stenosis?
Does percutaneous mitral commissurotomy provide long-term efficacy and prevent restenosis in patients with rheumatic mitral stenosis?
Percutaneous mitral commissurotomy achieves immediate procedural success in approximately 80% of patients with rheumatic mitral stenosis, though restenosis occurs in 38% over a mean 18.9-year follow-up and is predicted by Wilkins score >8, baseline mitral regurgitation, atrial fibrillation, and age >50 years.
Frequent long-term restenosis after PMC necessitates vigilant follow-up; leaves open validation of predictors in prospective cohorts.
Background Percutaneous mitral commissurotomy (PMC) is an established treatment for rheumatic mitral stenosis. Although immediate success is well documented, long-term durability and factors associated with restenosis remain clinically relevant. Purpose To evaluate long-term efficacy and identify predictors of restenosis after PMC in a 30-year single-center cohort. Methods We retrospectively analyzed 130 patients who underwent PMC between 1989 and 2019. Clinical, echocardiographic, and hemodynamic parameters were assessed before and after the procedure. Procedural success was defined as post-PMC mitral valve area (MVA) ≥1.5 cm² without significant mitral regurgitation. Restenosis was defined as MVA <1.5 cm² during follow-up. Results PMC significantly increased MVA from 1.08 ± 0.24 cm² to 2.01 ± 0.33 cm² (p<0.001), with significant reductions in transmitral gradients and pulmonary pressures. Procedural success was achieved in approximately 80% of patients. During a mean follow-up of 18.9 ± 8.6 years, restenosis occurred in 38% of cases. Restenosis was significantly associated with Wilkins score >8, baseline mitral regurgitation, atrial fibrillation, and age >50 years. No significant association was observed with NYHA class or baseline pulmonary pressures. Conclusion PMC provides durable long-term clinical benefit in rheumatic mitral stenosis. Anatomical valve characteristics and rhythm disturbances are key determinants of restenosis. Careful pre-procedural evaluation remains essential to optimize long-term outcomes.
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Amamou et al. (2026) studied this question.
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