Comparação entre comissurotomia e valvoplastia por cateter-balão na estenose mitral: cinco anos de acompanhamento Comparison of open commissurotomy and balloon valvuloplasty in mitral stenosis: a five-year follow-up

• Main Authors: Luiz Francisco Cardoso, Max Grinberg, Pablo Maria Alberto Pomerantzeff, Miguel Antonio Neves Rati, Caio Cesar Jorge Medeiros, Marcelo Luiz Vieira, Luiz Virgen, Flávio Tarasoutchi
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Cardiologia (SBC) 2004-09-01
• Series: Arquivos Brasileiros de Cardiologia
• Subjects: estenose da valva mitral; febre reumática; comissurotomia mitral; valvoplastia mitral por cateter-balão; mitral valve stenosis; rheumatic fever; mitral commissurotomy; balloon mitral valvuloplasty
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2004001500008
• ISSN: 0066-782X; 1678-4170

OBJETIVO: Comparar dados clínicos-laboratoriais em portadores de estenose mitral submetidos à comissurotomia ou valvoplastia por cateter-balão, obtidos ao longo de 5 anos de acompanhamento. MÉTODOS: Foram acompanhados, prospectivamente, 81 pacientes no pré (PRÉ), imediatamente após o procedimento (POI), e ao longo de cinco anos (PO12M, PO24M,..., PO60M) e randomizados em dois grupos: GC: 37 pacientes (32,4 &plusmn; 7,2 anos e 89,2% mulheres) e GV: 44 pacientes (32,9 &plusmn; 9,5 anos e 90,9% mulheres). A avaliação compreendeu: classe funcional, ocorrência de eventos, eletrocardiograma e ecodopplercardiograma. RESULTADOS: Houve melhora expressiva da classe funcional na maioria dos pacientes, três casos do GC e do GV estavam em classe funcional III no PO60M. Não houve diferença em relação ao gradiente mitral entre os grupos. Houve diferença das médias de área valvar mitral entre os grupos durante toda avaliação. Não ocorreram óbitos. No POI do GC observamos 3 casos com insuficiência mitral (IM) moderada, 3 com sangramento (1 reoperado) e, no GV, 4 casos com IM moderada, 1 com IM importante, 2 com tamponamento cardíaco, 1 caso necessitou cirurgia por IM importante. Ao longo de 60 meses, no GV, 9 casos evoluiram com IM moderada ou importante e no GC, 6 casos evoluiram com IM moderada ou importante e outros dois necessitaram cirurgia por dupla disfunção mitral. CONCLUSÃO: Ambos os métodos obtiveram 100% de sucesso com baixa taxa de complicações. No seguimento, houve elevação discreta do gradiente mitral e queda de área valvar mitral em ambos os grupos.<br>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 &plusmn; 7.2 years; 89.2% females); and GV (group undergoing balloon valvuloplasty): 44 patients (32.9 &plusmn; 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.