The efficiency and safety of balloon valvuloplasty in patients with mitral stenosis and a high echo score: Mid- and short-term clinical and echocardiographic results

Izmir Atatürk Eğitim ve Araştirma Hastanesi Kardiyoloji Kliniği, Izmir, Turkey.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 12/2009; 37(8):531-7.
Source: PubMed


We aimed to evaluate the success and safety of percutaneous mitral balloon valvuloplasty (PMBV) and its mid-term clinical and echocardiographic results in patients with symptomatic mitral stenosis, including those having a high echo score (9 to 11).
This prospective study included 57 consecutive patients (9 men, 48 women; mean age 41+/-9 years) who underwent PMBV with the Inoue technique for symptomatic (NYHA class II-IV) mitral stenosis (valve area <1.5 cm2). The patients were divided into two groups according to the echo scores of <or=8 (group 1, n=25) and >8 (group 2, n=32). Clinical and echocardiographic evaluations were performed before and after 24-48 hours of PMBV and during the follow-up period, including restenosis and major cardiovascular events.
Patients in group 2 had significantly higher rates of atrial fibrillation (53.1% vs. 16%; p=0.006) and functional capacity of NYHA class III-IV (90.7% vs. 56%; p=0.01). Procedural success rates were 96% (n=24) and 90.6% (n=29) in group 1 and 2, respectively. Failure occurred in one patient (4%) in group 1, and in three patients (9.4%) in group 2. One patient in group 1 developed severe mitral stenosis resulting in valve replacement. In group 2, two patients developed hemopericardium. After the procedure, there was a two-fold increase from 1.0+/-0.1 cm2 to 2.0+/-0.2 cm2 in the mean valve area, being more prominent in group 1 (group 1: from 1.1+/-0.1 cm2 to 2.1+/-0.1 cm2; group 2: from 0.9+/-0.1 cm2 to 1.8+/-0.1 cm2; p<0.001). In-hospital mortality or embolic events did not occur, nor did restenosis or major cardiovascular events during a mean follow-up of 21+/-13 months.
Our results show that PMBV can be performed successfully in patients having a low (<or=8) or higher (9-11) echo score, with satisfactory hemodynamic and symptomatic improvements.

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    ABSTRACT: We aimed to analyze acute clinical, echocardiographic, and hemodynamic results and long-term event-free survival of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of hemodynamically significant mitral stenosis (MS). We retrospectively reviewed 577 patients (454 females, 123 males; mean age 38±11 years) who underwent PMBV for moderate or severe MS. Acute procedural success was defined as the achievement of mitral valve area (MVA) >1.5 cm2 and absence of grade 3-4 mitral regurgitation. In addition, 489 patients were interrogated by phone calls for event-free survival (death, redo PMBV, mitral valve replacement) after at least one year (mean 54 months) of the procedure. The procedure was successful in 547 patients (94.8%) and unsuccessful in 30 patients (5.2%). Among baseline echocardiographic and hemodynamic parameters, MVA was significantly lower (p=0.0001) and moderate/severe tricuspid regurgitation was significantly more common (p=0.031) in patients with failure. The mean Wilkins scores were similar in the two groups (p>0.05). Failure was related to suboptimal valve opening (MVA <1.5 cm2) in 20 patients (66.7%), and grade 3-4 mitral regurgitation in 10 patients (33.3%). There were no in-hospital death, cardiac tamponade, or cerebrovascular accident. Acute complications included iatrogenic atrial septal defect (n=51, 8.8%) and groin hematoma (n=4, 0.7%). Inquiry for long-term outcomes showed that four patients had died, while 21 patients and six patients had undergone mitral valve replacement and redo PMBV, respectively. Our data suggest that PMBV is a safe and effective treatment option in MS and preprocedural MVA and tricuspid regurgitation are associated with acute failure of the procedure.
    No preview · Article · Mar 2011 · Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
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    ABSTRACT: Percutaneous mitral balloon valvuloplasty (PMBV) is the method of choice in treatment of patients with hemodynamically significant mitral stenosis. We aimed to analyze acute and long-term clinical and echocardiographic consequences of PMBV. In this retrospective cohort study; 311 patients who underwent PMBV in our Cardiology Clinic at Türkiye Yüksek İhtisas Education and Research Hospital between January 2000 and March 2004 were evaluated for acute procedural outcomes and primary endpoints (death, rePMBV, mitral valve replacement (MVR)). All 311 patients were contacted by phone call or letter at least five years after the procedure. Of the 311 patients, 87 who defined NYHA class II-IV symptoms were invited for a control visit and detailed echocardiographic evaluation. Sixty-three patients out of 87 who completed follow-up were enrolled for long-term consequences. Those 63 patients were subclassified into two groups as those without any negative event (n=26) (Group 1) and those with mitral valve area (MVA) (<1.5 cm(2)), rePMBV or referral to MVR (n=37) (Group 2) on follow up to 6.4±1.6 years. In the analysis of 311 patients, acute post procedural success, which was defined as mitral valve area (MVA) ≥1.5 cm(2) without severe mitral regurgitation, was 94% and was only associated with preprocedural MVA (p=0.008). In the logistic regression analysis, preprocedural MVA was the only independent parameter, associated with acute procedural success (Expβ=0.004, 95%CI 0.0001-0.234, p=0.008). In the long-term follow up of 63 patients, the patients with uneventful course (Group 1) had significantly higher MVA (p<0.001), lower mean (p=0.001) and peak (p<0.001) transmitral gradients immediately after the procedure when we compared to the patients in Group 2. It was also noticed that patients with at least 60% improvement in MVA experienced composite end point much less frequently compared to those with less than 60% improvement in MVA (5% vs. 30.4%, p=0.009). Kaplan-Meier analysis yielded significantly diverging cumulative survival curves for those with and without at least 60% improvement in MVA (p=0.003). Concerning long-term follow up data of patients undergoing PMBV in a single center, it seems only acute postprocedural MVA was significantly associated with long-term consequences.
    Full-text · Article · Sep 2011 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
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    ABSTRACT: Objective We aimed to assess the impact of atrioventricular compliance (Cn) on the clinical outcome, after successful percutaneous balloon mitral valvuloplasty (PBMV). Methods and ResultsUsing Doppler echocardiography Cn was estimated from the equation that has been previously validated. Mitral valve area (MVA), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure (PAP), and degree of tricuspid regurgitation (TR) severity were evaluated before, immediately, and every 6months with a median duration of 32months after successful PBMV in 150 consecutive patients. An immediate drop in PAP and significant improvement of right ventricle (RV) function was observed after PBMV. Cn was negatively correlated pre and post-PBMV, with the degree of pulmonary artery systolic pressure (PAPs), TAPSE (P<0.0001). Patients with Cn3.75mL/mmHg had higher incidence of adverse outcome (developing atrial fibrillation [AF], worsening RV function, progressive left atrial dilation, and redo intervention). Multivariate regression analysis showed that the Cn was the strongest independent predictor of PAPs and RV function before and after successful PBMV (P<0.0001). Cn3.75mL/mmHg was the cutoff value for prediction of clinical events at follow-up. Conclusions Atrioventricular compliance was significantly lower in patients with mitral stenosis (MS) with unfavorable outcome after successful PBMV. The RV function and pulmonary hypertension were significantly correlated with the degree of Cn. This suggests a significant role of Cn in patients with MS, providing a good insight for intervention and utilizing Cn as a noninvasive hemodynamic index for risk stratification and proper timing for intervention in patients with MS.
    No preview · Article · Jun 2013 · Echocardiography