La commissurotomie mitrale percutanée chez les sujets âgés de 60 ans et plus

Of 745 patients treated by balloon mitral commissurotomy (BMC) between February 1988 and December 2002, 45 were ≥ 60-years old. Immediate and late outcomes in this group (group 1) were compared with those in the patients aged < 60-years (group2). Baseline hemodynamic parameters were comparable in the two groups. Mitral surface area and hemodynamic parameters improved significantly after BMC in group1: mean left atrial pressure fell from 18.76 ± 6.18 to 10.65 ± 4.38 mmHg (P < 0.001), mean transmitral gradient from 11.03 ± 4.70 to 4.63 ± 2.05mmHg (p < 0.001) and mitral valve area from 0.99 ± 0.22 to 1.88 ± 0.41cm2 (p < 0.001). Similar significant improvements were seen in group 2. The hemodynamic result was good in 69% of group1 patients. Tamponade occurred in one patient. Mitral regurgitation grade I or II developed in 8 patients and remained stable in 13 patients. These complication rates were comparable to those seen in group 2. In the group 1, a good result was maintained in 60% of patients after 43 ± 23 months of fllow-up. Although restenosis was observed in 40% of patients, functional amelioration was obtained in most of cases. In the group 2, restenosis was observed in 25% of patients. The data from this study suggest that BMC is effective first therapy in patients aged ≥ 60-years with symptomatic mitral stenosis.