Document Detail

Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis. A prospective, randomized trial.
MedLine Citation:
PMID:  2013139     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We performed a prospective, randomized trial comparing percutaneous balloon commissurotomy with surgical closed commissurotomy in 40 patients with severe rheumatic mitral stenosis. METHODS AND RESULTS: Data were analyzed by investigators who were masked to treatment assignment or phase of study. Patients randomized to balloon (n = 20) or surgical (n = 20) commissurotomy had severe mitral stenosis without significant baseline differences (left atrial pressure, 26.1 +/- 4.2 versus 27.6 +/- 6.2 mm Hg; mitral valve gradient, 18.0 +/- 4.2 versus 19.7 +/- 6.3 mm Hg; mitral valve area, 1.0 +/- 0.2 versus 1.0 +/- 0.4 cm2, respectively). At 1-week follow-up after balloon commissurotomy, pulmonary wedge pressure was 14.3 +/- 7.2 mm Hg; mitral valve gradient was 9.6 +/- 5.1 mm Hg; and mitral valve area was 1.6 +/- 0.6 cm2 (all p less than 0.0001). At 1-week follow-up after surgical closed commissurotomy, wedge pressure was 13.7 +/- 5.4 mm Hg; mitral valve gradient was 9.4 +/- 4.2 mm Hg (both p less than 0.0001); and mitral valve area was 1.6 +/- 0.7 cm2 (p less than 0.003). At 8-month follow-up, improvement occurred in both groups: Mitral valve area was 1.6 +/- 0.6 cm2 in the balloon commissurotomy group (p less than 0.002) and was 1.8 +/- 0.6 cm2 in the surgical closed commissurotomy group (p less than 0.0001). There was no difference between the groups at 1-week or 8-month follow-up (all p greater than 0.4). One case of severe mitral regurgitation occurred in each group; complications were otherwise related to transseptal catheterization. There was no death, stroke, or myocardial infarction. Cost analysis revealed that balloon commissurotomy may substantially exceed the cost of surgical commissurotomy in developing countries, whereas it may represent a significant savings in industrialized nations. CONCLUSIONS: We conclude that percutaneous balloon commissurotomy and surgical closed commissurotomy result in comparable hemodynamic improvement that is sustained through 8 months of follow-up.
Z G Turi; V P Reyes; B S Raju; A R Raju; D N Kumar; P Rajagopal; P V Sathyanarayana; D P Rao; K Srinath; P Peters
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  83     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1991 Apr 
Date Detail:
Created Date:  1991-05-14     Completed Date:  1991-05-14     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1179-85     Citation Subset:  AIM; IM    
Department of Medicine, Harper Hospital, Detroit, MI 48201.
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MeSH Terms
Balloon Dilatation* / economics
Costs and Cost Analysis
Mitral Valve / surgery
Mitral Valve Stenosis / surgery,  therapy*
Prospective Studies
Rheumatic Heart Disease / surgery,  therapy*
United States
Comment In:
Circulation. 1991 Apr;83(4):1450-1   [PMID:  2013161 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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