What are the differences in presentation of candidates for percutaneous mitral commissurotomy across the world and do they influence the results of the procedure?

Background. - Despite marked global differences in the prevalence of rheumatic heart disease, little is known about geographic variations in the characteristics of patients with severe mitral stenosis. Aim. - To determine if differences in rheumatic fever epidemiology influence the characteristics of patients with mitral stenosis and the immediate results of percutaneous mitral commissurotomy (PMC). Methods. - We compared 350 patients (mean age: 41 +/- 17 years, 81% women) scheduled for PMC in five non-Western and two Western countries. Fifty consecutive patients were included in each centre. All presented a mitral valve area less than 1.5 cm(2) and were in New York Heart Association (NYHA) functional class greater or equal to 11, with no contraindications to PMC. Results. - The 250 patients from non-Western countries were younger than the 100 patients from Western countries (35 +/- 12 vs 57 +/- 15 years, p < 0.0001) and had more severe valve disease, assessed by indexed valve area (0.57 +/- 0.14 vs 0.62 +/- 0.14 cm(2)/m(2) body surface area, p = 0.006), mean gradient (15 +/- 6 vs 8 +/- 4 mmHg, p < 0.0001) and systolic pulmonary artery pressure (57 +/- 21 vs 42 +/- 14 mmHg, p < 0.0001). PMC complication rates did not differ significantly. Good immediate PMC results were observed in 225 patients (90%) in non-Western and 88 (88%) in Western centres (p = 0.58). Conclusions. - Compared with Western countries, PMC candidates from non-Western countries are younger, with more severe valve stenosis. However, PMC achieves good immediate results in a similarly high proportion of patients, showing the wide applicability of this technique. (C) 2008 Elsevier Masson SAS. All rights reserved.