Percutaneous Balloon Mitral Valvuloplasty in Children and Adolescents With Juvenile Rheumatic Mitral Stenosis: Single Centre Experience

Background Rheumatic mitral stenosis (MS) in India is known to affect at a younger age, worsen rapidly, and have severe valvar and subvalvar pathology. Surgical interventions involve the risk of needing to redo surgery in the future, in addition to the acute risks of surgery itself and cardiopulmonary bypass. Therefore, percutaneous balloon mitral valvuloplasty (PBMV) has become an attractive alternative option, especially in children who rarely have any significant calcifications. Method We report our experience of PBMV in this retrospective study of 46 patients, aged 9 to 17 years (23 males, 23 females), with all being in the New York Heart Association (NYHA) class II/III. Seven patients had significant subvalvar pathology. All patients had severe pulmonary arterial hypertension (PAH). We used Accura balloons (Accura Medizintechnik GmbH, Karben, Germany) and estimated balloon size based on the height formula and used balloons 1-3 mm smaller than those derived from the formula. Results We used a smaller balloon in all the patients and had to upgrade in only seven cases. There was a significant reduction in the transmitral gradient from 19.93±6.21 mmHg to 3.54±1.1 mmHg (p<0.001) and a significant increase in the area of the mitral valve from 0.75±0.18 cm² to 1.6±0.2cm² (p<0.001). There was immediate symptomatic improvement in all patients, and there was no mortality. Moderate mitral regurgitation (MR) developed in six patients, one patient developed severe MR, and only one of them had subvalvar pathology. Conclusion Our results indicate that PBMV is an effective procedure in the younger population with juvenile MS. PBMV performed with undersized balloons (1-3 mm smaller than the height-based estimate) demonstrated comparable efficacy and safety, even in patients with subvalvular pathology.