What are the differences in presentation of candidates for percutaneous mitral commissurotomy across the world and do they influence the results of the procedure?

BACKGROUND

Despite marked global differences in the prevalence of rheumatic heart disease, little is known about geographic variations in the characteristics of patients with severe mitral stenosis.

AIM: To determine if differences in rheumatic fever epidemiology influence the characteristics of patients with mitral stenosis and the immediate results of percutaneous mitral commissurotomy (PMC).

METHODS

We compared 350 patients (mean age: 41+/-17 years, 81% women) scheduled for PMC in five non-Western and two Western countries. Fifty consecutive patients were included in each centre. All presented a mitral valve area less than 1.5 cm2 and were in New York Heart Association (NYHA) functional class greater or equal to II, with no contraindications to PMC.

RESULTS

The 250 patients from non-Western countries were younger than the 100 patients from Western countries (35+/-12 vs 57+/-15 years, p<0.0001) and had more severe valve disease, assessed by indexed valve area (0.57+/-0.14 vs 0.62+/-0.14 cm2/m2 body surface area, p=0.006), mean gradient (15+/-6 vs 8+/-4 mmHg, p<0.0001) and systolic pulmonary artery pressure (57+/-21 vs 42+/-14 mmHg, p<0.0001). PMC complication rates did not differ significantly. Good immediate PMC results were observed in 225 patients (90%) in non-Western and 88 (88%) in Western centres (p=0.58).

CONCLUSIONS

Compared with Western countries, PMC candidates from non-Western countries are younger, with more severe valve stenosis. However, PMC achieves good immediate results in a similarly high proportion of patients, showing the wide applicability of this technique.