VALVULAR HEART DISEASE Original Studies Immediate and Long-Term Results of Percutaneous Mitral Balloon Valvotomy in Asymptomatic or Minimally Symptomatic Patients With Severe Mitral Stenosis Mohamed Eid Fawzy, 1 * FRCP, FACC, FESC, Mohamed Shoukri, 2 PhD, Walid Hassan, 1 FACC, FACP, FCCP, FSCAI, Amr Badr, 1 MD, Ali Hamadanchi, 1 MD, Abdulmoniem ElDali, 1 and Jehad Al Buraiki, 1 FRCPC The purpose of this study was to evaluate the safety and value of percutaneous mitral balloon valvotomy (PMBV) in asymptomatic or minimally symptomatic patients with severe mitral stenosis (MS). There are very limited data supporting the concept of PMBV in asymptomatic or minimally symptomatic patients with severe MS. We ana- lyzed the results of 539 consecutive patients with severe MS who underwent PMBV at our hospital. Patients were divided according to their symptoms at the time of PMBV into group A (55 patients), who had few or no symptom (NYHA class 1 or 2), and group B (484 patients), who had severe symptom (NYHA class 3 or 4). Patients had clinical and echocardiographic follow-up for 0.5–15 years. There was no significant difference in baseline characteristics between the two groups. The immediate mitral valve area (MVA) was equal in both groups. The follow-up MVA was larger in group A (1.9 6 0.38 vs. 1.7 6 0.4 cm 2 ; P = 0.002), and restenosis occurred in 11% in group A vs. 23% in group B (P ¼ 0.023). Actuarial freedoms from restenosis at 5, 10, and 13 years were significantly higher for group A than for group B (97% 6 2%, 77% 6 9%, 77% 6 9% vs. 85% 6 1%, 62% 6 3%, 39% 6 5%; P = 0.0018). Atrial fibrillation at follow-up was encountered in 11% in group A vs. 20% in group B (P ¼ 0.042). There was a significant reduction of the left atrial size in both groups. Event-free survivals at 5, 10, and 13 years were higher for group A than for group B (97% 6 2%, 80% 6 9%, 80% 6 9% vs. 86% 6 1%, 65% 6 3%, 42% 6 3%; P = 0.0018). This study demonstrated excellent immediate results of PMBV in asymptomatic or minimally symptomatic patients with severe MS and long-term results are better compared to the reported natural history of such patients. We recommend mitral balloon valvotomy (MBV) for patients with severe MS with few or no symptoms, provided the valve morphology is suitable for MBV. ' 2005 Wiley-Liss, Inc. Key words: rheumatic heart disease; mitral valve; valvuloplasty INTRODUCTION In the past, patients with asymptomatic mitral steno- sis (MS) were thought to have a good prognosis. Con- sequently, surgery, which was the only option of treat- ment, was only considered after the onset of symp- toms. However, it is now possible to have a different outlook in the light of the current knowledge of asymptomatic MS, in particular regarding the embolic risk and also because of the development of mitral bal- loon valvotomy since 1982 [1], enabling effective treatment to be performed at low risk. However, there are very limited data [2,3] supporting the concept of 1 King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia 2 Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Cen- ter, Riyadh, Saudi Arabia *Correspondence to: Mohamed Eid Fawzy, King Faisal Heart Insti- tute, MBC-16, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia. E-mail: fawzy100@hotmail.com Received 10 March 2005; Revision accepted 12 May 2005 DOI 10.1002/ccd.20482 Published online 8 September 2005 in Wiley InterScience (www. interscience.wiley.com). ' 2005 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 66:297–302 (2005)