Homograft - the optimal aortic valve substitute?

valvuloplasty can be performed safely and with satisfactory results in over 85% of these patients. It is also possible that repeat PMV can be performed in these patients with acceptable risks and results. In our own single centre experience in about 390 procedures repeat percutaneous balloon valvuloplasty was performed in 17 cases (mean age 65 13 years) without any increase in the rate of acute complications (no death, no embolic event, no tamponade) and with acceptable haemodynamic results (valve area >1·5 cm in 15 patients). In elderly patients, mitral valve replacement is often associated with an increase in morbitidy and mortality during surgery and at follow up. Therefore by avoiding the apparent risk of mitral valve replacement a suboptimal haemodynamic result of percutaneous balloon valvuloplasty resulting in an improvement of one NYHA class, which is achieved even in degenerated and calcified valves, may be of clinical significance and sufficient for mid-term improvement in these patients. In addition, the costs of a repeat percutaneous balloon valvuloplasty are considerably lower compared to mitral valve replacement. In summary, percutaneous balloon valvuloplasty should be considered as the first option in patients with restenosis after surgical commissurotomy or percutaneous balloon valvuloplasty. Open commissurotomy should be performed only in selected patients in whom direct visualization of the mitral valve seems to be advantageous, e.g. patients with severe subvalvular disease, calcification, or thrombus who are judged to be candidates for plastic procedures rather than mitral valve replacement. In all cases where mitral valve replacement is considered the somewhat better haemodynamic results should be weighted against the increased periand postoperative risk, especially in elderly patients. U. ZEYMER K.-L. NEUHAUS Medizinische Klinik II, Klinikum Kassel, Germany