Percutaneous mitral balloon commissurotomy in juvenile rheumatic mitral stenosis patients: a ten-year experience from Ethiopia.

BACKGROUND: Rheumatic heart disease (RHD) remains a major cause of acquired valvular heart disease in low- and middle-income countries, disproportionately affecting young people. The mitral valve is most frequently involved, and severe rheumatic mitral stenosis (MS) represents the dominant presentation. MS is a progressive disease that gradually impairs cardiac output and, if untreated, leads to pulmonary hypertension, right-sided heart failure, and premature death. Percutaneous mitral balloon commissurotomy (PMBC) is considered the first-line intervention for symptomatic severe MS with favorable valve anatomy. This study aimed to assess the clinical, echocardiographic, and procedural outcomes of PMBC among juvenile patients with rheumatic MS in Ethiopia. METHODS: A Descriptive cross-sectional study was conducted at the Cardiac Center Ethiopia, Addis Ababa, from July to August 2025. All consecutive patients who underwent PMBC during the study period and fulfilled eligibility criteria were included (n = 86). Data were analyzed using STATA 17. Continuous variables were expressed as means ± SD or medians (IQR), and categorical variables as frequencies and percentages. Pre- and post-procedure echocardiographic and clinical parameters were compared using paired statistical tests. Associations between baseline characteristics and immediate outcomes were examined using Fisher’s exact tests. RESULTS: The median age was 15 years (± 5), and 60.5% (n = 52) were female. Patients originated from multiple Ethiopian regions, predominantly Amhara 28 (32.6%) and Oromia 25 (29.1%), with 65.06% residing in Rural areas. Severe MS accounted for 84 (97.7%) of cases, while 2 patients (2.3%) presented with severe restenosis. 82 (95.4%) had a mitral valve score ≤ 8. The mitral valve area increased significantly from 0.6 cm² (IQR: 0.26) to 1.5 cm² (IQR: 0.6), and the mean mitral gradient decreased from 31.4 ± 8.3 mmHg to 16.4 ± 5.6 mmHg (both p < 0.001). Procedural success was achieved in 85 cases (98.84%). CONCLUSION: PMBC in juvenile patients with severe rheumatic MS in Ethiopia is a safe and effective intervention, demonstrating significant improvements in mitral valve area and mean mitral gradient, with a high procedural success rate.