Balloon mitral commissurotomy in children.

Of the 440 patients treated by balloon mitral commissurotomy (BMC) between February 1988 and December 1995 at the cardiology department of the Sahloul Teaching Hospital in Sousse, Tunisia, 30 were lj years of age or younger. The double balloon technique was used in 24 patients (80%) and the Inoue technique in six (20%). Mitral valve area and hemodynamic parameters showed highly significant improvements after BMC: mean left atrial pressure fell from 24.64 +/- 5.32 to 11.37 +/- 4.32 mmHg (P < 0.001), mean transmitral gradient fell from 18.51 +/- 5.19 to 6.17 +/- 3.04 mmHg (P < 0.001), and mitral valve surface area (MVSA) increased from 0.79 +/- 0.24 to 1.85 +/- 0.49 cm(2) (P < 0.001). Complete success defined as a post-BMC MVSA greater than 1.5 cm(2) and mitral regurgitation less than 2 + was obtained in 23 patients (76.6%). Acute intraoperative complications were seen in three patients, and consisted of one case of complete heart block and two of tamponade successfully treated by percutaneous pericardiocentesis in the catheterization laboratory. Ten cases of mitral regurgitation during BMC were recorded, of which eight were mild (1 +), one was moderate (2 +), and one was severe (3 +). None of the patients had an atrial septal defect with a QP/QS ratio greater than 1.5 by oximetry. These data suggest that BMC is an excellent treatment option for children with mitral stenosis.