Comparative study of percutaneous transvenous mitral commissurotomy using ACCURA balloon in juvenile vs adult rheumatic mitral stenosis

Abstract

Objective: Mitral stenosis (MS) is rarely seen in children and adolescents but is not uncommon in developing countries where rheumatic fever is still endemic. Rheumatic MS in India commonly affects children and young adults less than 20 years old (juvenile mitral stenosis). Although percutaneous transvenous mitral commissurotomy (PTMC) using the ACCURA balloon catheter has been shown to be safe and effective technique in large series of adult patients, reports of this technique in children are scarce. In our study, we aim to evaluate the immediate and early follow-up results of PTMC in 50 patients of rheumatic MS age ≤ 20 years and compare the same with those of the patients aged > 20 years . Methods: Fifty consecutive patients aged ≤ 20 years with symptomatic rheumatic MS who met the inclusion criteria and whose valves are suitable for PTMC formed the cases, another 50 consecutive patients aged > 20 years with similar characteristics formed the control group. PTMC was done for both the groups as per the standard protocol and hemodynamic and echocardiography parameters were noted. Appropriate statistical tests were used to compare these data. Results: The juvenile group had more often severe MS than adult patients at baseline [mitral valve area (MVA) 0.77(0.16) cm 2 vs. 0.86(0.15) cm 2 , p<0.0069