Abstract: Since it description in 1984, percutaneous mitral commissurotomy (PMC) has been widely used and its indications have been progressively widened. The Inoue technique is now the most widely used, in particular because of its ease of use and its safety, as attested by the low rates of mortality and complications seen in series from experienced centers. The most frequent complication is severe traumatic mitral regurgitation. Immediately after PMC, there is a mean doubling of mitral valve area. Good late functional results are observed in 33 to 72% of patients at 10-12 years, the wide range of rates depending on differences in patient characteristics between series. The most frequent cause of late deterioration is mitral restenosis. Analyses performed in large series have shown that the prediction of immediate and late results of PMC is multifactorial. Besides the severity of the impairment of valve anatomy, age, symptoms, atrial fibrillation and prior commissurotomy have a strong impact on patient outcome.
According to guidelines, percutaneous mitral commissurotomy is now the reference treatment for mitral stenosis with pliable valves in young patients and its efficacy has been validated in randomised trials versus surgery. Mitral stenosis in older patients with more severe impairment of valve anatomy is the most frequent presentation of mitral stenosis in industrialized countries. In this heterogeneous group, PMC should be considered in patients who have otherwise favourable characteristics. PMC can also be considered in selected asymptomatic patients, in particular in order to reduce the thromboembolic risk.
After more than 20 years, PMC is now a mature technique and has virtually replaced surgical commissurotomy in industrialised countries. PMC and valve replacement should be considered as complementary techniques applicable in the different stages and presentations of mitral stenosis.