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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe use of mitral valvotomy is primarily limited to developing countries, where it increases survival without the need for reinterventions. The selection of the optimal type of valvotomy requires careful patient selection and evaluation of facility and operator factors must be evaluated.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emitral valvotomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EWilkins Score\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eballoon mitral valvotomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epercutaneous mitral commissurotomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emitral valve area\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Escoring systems\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evalvuloplasty\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EMitral valvotomy is primarily used in the developing world because of the constraints in those countries, stated F. E. Smit, MD, University of the Free State, Bloemfontein, South Africa. Survival is increased, with an excellent or normal lifestyle, without the need for reintervention. A number of factors must be considered to select the type of valvotomy, including patient factors (eg, where the patient lives and the stage of the disease) as well as facility and operator factors (eg, level of training and available resources).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESeveral scoring systems have been developed to help optimize patient selection. The Wilkins score evaluates the extent of valvular disease and identifies patients who may be eligible for balloon valvotomy. Additional scores help predict long-term outcomes in patients with severe mitral stenosis, and a recent scoring system based on 20-year follow-up to obtain ideal results is guided by scoring systems such as the Wilkins score. Prognostic scoring systems for outcomes after balloon mitral valvotomy (BMV) include the transesophageal echocardiography (ECHO) assessment of commissure morphology [Sutaria N et al. \u003Cem\u003EHeart.\u003C\/em\u003E 2006] and the scoring system by Zhang and colleagues that predicts late outcomes in patients with severe mitral stenosis [Zhang HP et al. \u003Cem\u003EAm Heart J.\u003C\/em\u003E 1997]. A recent scoring system is based on the factors that predict late function as identified from the 20-year follow-up of patients who underwent percutaneous mitral commissurotomy (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Bouleti C et al. \u003Cem\u003ECirculation.\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16902\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16902\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16902\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EFactors That Predict Late Outcomes After Percutaneous Mitral Commissurotomy\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EClosed mitral commissurotomy (CMC) and open mitral commissurotomy (OMC) provided similar survival at 30 years (49.1% vs 45.9%; \u003Cem\u003EP\u003C\/em\u003E = NS), but the need for another procedure was lower with OMC (5 patients vs 44 with CMC; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .05), as shown by Detter and colleagues [Detter C et al. \u003Cem\u003EAnn Thorac Surg.\u003C\/em\u003E 1999]. A series by Chen and colleagues substantiated the hemodynamic improvements achieved with valvotomy [Chen CR, Cheng TO. \u003Cem\u003EAm Heart J.\u003C\/em\u003E 1995].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPercutaneous mitral valvotomy using the double balloon technique provided similar results as CMC and the improvement in mitral valve area (MVA) was durable at the 15-year follow-up (mean follow-up 99 months) [Rifaie O et al. \u003Cem\u003EJ Cardiol.\u003C\/em\u003E 2009]. Mitral restenosis occurred in 5 patients in each group. The durable results with BMV were also shown by Farhat and colleagues in their 7-year follow-up [Farhat MB et al. \u003Cem\u003ECirculation.\u003C\/em\u003E 1998].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EOMC provided a durable improvement in MVA in a series of 100 patients with mitral stenosis [Antunes MJ et al. \u003Cem\u003EJ Heart Valve Dis.\u003C\/em\u003E 2000]. The mean MVA was 0.99 cm\u003Csup\u003E2\u003C\/sup\u003E before surgery, increased to 2.89 cm\u003Csup\u003E2\u003C\/sup\u003E after surgery, and was 2.37 cm\u003Csup\u003E2\u003C\/sup\u003E on Doppler ECHO at the mean 8.5-year follow-up. An MVA \u0026gt; 2.0 cm\u003Csup\u003E2\u003C\/sup\u003E was found in 81% of patients at follow-up. Importantly, this study showed that a postintervention MVA between 1.3 and 1.5 cm\u003Csup\u003E2\u003C\/sup\u003E should not be considered a success, stated Prof Smit.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EValvuloplasty is ideal for complex disease, which includes all valves with pathology extending beyond the leaflet and valvular structural disease, as defined by the scoring systems. Such valves likely require either valvuloplasty or valve repair for the first attempt at valve salvage, stated Prof Smit.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe selection of a percutaneous or surgical procedure is determined by the available expertise, infrastructure, and cost. If both options are available, Prof Smit recommends BMV as the first choice, or CMC, if the patient is an ideal candidate according to the scoring systems. OMC should be performed for all other patients. An irreparable valve should be replaced because the possibility of another surgery may not be available in developing countries. A diagnostic program for early detection should be established.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/16\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlkb2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlkb2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}