Comparison of open commissurotomy and balloon valvuloplasty in mitral stenosis. A five-year follow-up.

OBJECTIVE To compare clinical and laboratory data in patients with mitral stenosis undergoing open commissurotomy or balloon valvuloplasty, who were followed up for 5 years. METHODS Eighty-one patients were prospectively assessed prior to the procedure (PRE) and immediately after the procedure, in the immediate postoperative period (IPO), and followed up yearly for 5 years (PO12M, PO24M, PO36M, PO48M, and PO60M). They were randomized into the following 2 groups: GC (group undergoing open commissurotomy): 37 patients (32.4 +/- 7.2 years; 89.2% females); and GV (group undergoing balloon valvuloplasty): 44 patients (32.9 +/- 9.5 years; 90.9% females). The patients' assessment comprised the following items: functional class, occurrence of events, electrocardiography, and Doppler echocardiography. RESULTS A significant improvement in functional class occurred in most patients. Three patients in GC and in GV were in functional class III in PO60M. No difference in the mitral gradient was observed between the groups. A difference in the mean mitral valve areas was observed between the groups during the entire evaluation. No patients died. In regard to the IPO of GC, 3 patients had moderate mitral insufficiency (MI), and 3 had bleeding (1 was reoperated upon). In the IPO of GV, 4 patients had moderate MI, 1 had severe MI, 2 had cardiac tamponade, and 1 patient required surgery due to severe MI. Over 60 months, 9 GV patients evolved to moderate or severe MI, while 6 GC patients evolved to moderate or severe MI, and 2 other GC patients required surgery due to double mitral dysfunction. CONCLUSION The rate of success in open mitral commissurotomy and balloon mitral valvuloplasty was 100%, and the rate of complications was low. During follow-up, a mild elevation in mitral gradient and a drop in mitral valve area were observed in both groups.