Percutaneous Mechanical Mitral Commissurotomy with the Metallic Valvulotome: Detailed Technical Aspects and Overview of the Results of the Multicenter Registry on 882 Patients

Percutaneous mechanical mitral commissurotomy (PMMC) is a new technique that has been developed over the last 3 years for the treatment of mitral stenosis. The device used opens the commissures by a direct action of two parallel bars located in a metallic head screwed at the distal end of a 13Fr catheter. Opening of the bars is obtained with the use of activating pliers attached at the proximal end of the catheter. The metallic dilator and the pliers can be safely reused after sterilization. The device and the direrent steps of the procedure are detailed in this article. The results of an international registry including 882 patients are reported here. PMMC could be achieved in 863 (98%) cases. Maximal opening of the bars was 40 mm in 90% of the cases. The technique resulted in an increase of the mitral valve area from 0.94 ± 0.2 cm² to 2.12 ± 0.4 cm². Bilateral splitting of the commissures was achieved in 85% of the cases. Complications occurred in 33 (3.7%) patients: pericardial tamponade in 1.4% (12 cases, one death), mitral regurgitation > grade 2 in 2.1% (18 cases, surgery required in 4), and transient stroke in 0.3% (3 patients). The role of the learning curve in the occurrence of complications has been clearly demonstrated. The cost of the procedure has been markedly decreased in developing countries due to multiple reuses of the device after sterilization.