Non-surgical mitral valvuloplasty for rheumatic mitral stenosis

One hundred and twenty-six patients of rheumatic mitral stenosis (MS), aged 10-30 (mean 19.5 +/- 5.9) years underwent balloon mitral valvuloplasty (BMV). All valvuloplasties were done by the anterograde transvenous, transatrial route. The procedure was successful in 120 (95%) cases. Single balloon was used in 10 patients early in the series and double balloon was used in the other 110 patients. BMV resulted in a significant increase in the mitral valve area (MVA) from 0.96 +/- 0.35 to 2.3 +/- 0.8 cm2 (p less than 0.0001) and a significant fall in the transmitral pressure gradient (TMG) from 28.2 +/- 3.2 to 7.4 +/- 4.8 mmHg (p less than 0.001). The MVA achieved by BMV was found to have a significant positive correlation with the balloon diameter to body surface area ratio (BD/BSA) (r = 0.69, p less than 0.001). New mitral regurgitation (MR) developed in 15 patients--trivial in 11, 2+ in 2 and 3+ in 2. One patient required emergency mitral valve replacement. Procedure induced MR did not have a significant relation to the balloon size, degree of mitral sub-valvular pathology or the severity of mitral stenosis. Iatrogenic atrial septal defect was detected by oximetry in none, by angiography in one patient, and by Doppler color flow imaging in 5 patients. Cardiac tamponade was the most frequent serious complication, occurring in 6 patients, 4 of whom died following emergency surgery. Sixty-five patients have been followed up for at least 6 months (range 6-30, mean 16.3 +/- 6.3 months) following BMV.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immediate and midterm outcome of balloon mitral valvotomy in children and adolescents

BACKGROUND: The midterm and long term results of balloon mitral valvotomy (BMV) have not been well characterized, particularly in those below the age of 20 years. AIM: The present study evaluated the hemodynamic benefits, safety and efficacy, as well as the midterm follow-up results, of Inoue BMV in children and adolescents less than 20 years of age who have severe mitral stenosis. PATIENTS: Sixty-one patients younger than 20 years of age underwent BMV between December 1989 and May 1998. METHODS: All patients underwent BMV using the Inoue balloon for symptomatic severe mitral stenosis with a mitral valve area less than 1.2 cm2. Cardiac hemodynamics were acquired before and immediately after BMV. In addition, Doppler echocardiography measurements were obtained during follow-up. RESULTS: The procedure was successful in 59 patients (96.7%). There were no deaths during the procedure or during follow-up. The mean Boston Mitral Echo score was 7.4 1.4. Mitral valve area on cardiac catheterization increased from 0.8 0.3 to 1.9 0.6 cm2 (P<0.001), and the mean mitral valve gradient decreased from 16.9 5 to 5.8 2.8 mmHg (P<0.001). Severe mitral regurgitation developed in one patient (1.6%) and cardiac tamponade developed in two. At a mean follow-up of 36.9 27 months (range 12 to 84 months), mitral valve area by Doppler echocardiography remained at 1.7 0.4 cm2 and the mean mitral valve gradient by Doppler echocardiography was 6 2 mmHg. CONCLUSIONS: BMV is safe and effective in children and adolescent patients with rheumatic mitral stenosis and provides a similar hemodynamic benefit with that reported in adults. The benefits were sustained during a mean follow-up period of 36 months.     

Balloon mitral valvulotomy in children aged < or = 12 years

BACKGROUND AND AIM OF THE STUDY: Balloon mitral valvulotomy (BMV) was studied in children aged < or = 12 years to study its efficacy, to assess the effects of age and body surface area on outcome, and to determine whether the definition of mitral stenosis and recommendations for balloon size used in adults are applicable to very young patients. At present, data on BMV or guidelines for balloon size in small children are not available. METHODS: Clinical, echocardiographic and hemodynamic data were obtained from 13 patients before and after BMV. At follow up, correlation coefficients were identified for clinical, echocardiographic or procedural variables with increase in the degree of mitral regurgitation (MR), age and body surface area. RESULTS: BMV was successful in 12 patients (93%), with increased valve area and cardiac index and decreased left atrial and pulmonary artery pressure gradients. Moderate MR developed in two patients (15%), but did not correlate with any variable. Symptom improvement was seen at follow up. Seven patients (54%) experienced adverse events: restenosis occurred in five cases (38%), and symptom recurrence and valve replacement for endocarditis occurred in one patient (8%). Kaplan-Meier analysis showed that by 20 months after BMV, 60% of patients had experienced an event. The percentage fall in pulmonary artery pressure correlated with body surface area, but not age. CONCLUSION: BMV is effective in very small children, but a high incidence of moderate MR occurs, mainly because the choice of balloon size is made using an adult-style, height-based nomogram and a stepwise increase in balloon size during BMV. Correct nomograms to define mitral stenosis, restenosis and balloon size must be developed for small children.     

Echocardiographic evaluation of mitral valve structure and function in patients followed for at least 6 months after percutaneous balloon mitral valvuloplasty

Although beneficial results have been reported immediately after percutaneous mitral balloon valvuloplasty, little information is available concerning the longer-term outcome of this procedure. The anatomic and functional results of percutaneous mitral valvuloplasty were assessed in 20 patients, in whom two-dimensional and Doppler echocardiographic examination could be obtained both immediately and 6 to 11 months (mean 7.5 +/- 2.0) after balloon dilation. Mean valve area measured by planimetry decreased slightly but significantly from 1.90 +/- 0.59 cm2 immediately after valvuloplasty to 1.62 +/- 0.55 cm2 (p less than 0.001) at follow-up. Individual changes in valve area were variable, and in four patients valve area decreased by greater than 25%. Echocardiographic scores of valvular morphology were obtained by assigning scores of 0 to 4 (with increasing abnormality) to each of four morphologic characteristics of the valve, namely, leaflet mobility, thickening, calcification and subvalvular thickening. This score was higher in the four patients with a decrease in valve area greater than 25% at follow-up than in the other patients (11 +/- 2 versus 7 +/- 2, p less than 0.002). Multiple regression analysis of several hemodynamic and echocardiographic factors identify first the echocardiographic score and second the valve area postvalvuloplasty as the only significant predictors of the percent decrease in valve area (r = 0.70, p less than 0.006). Mitral regurgitation graded by pulsed Doppler ultrasound decreased from 1.9 +/- 1.2 immediately after valvuloplasty to 1.0 +/- 0.9 (p less than 0.003) at follow-up, whereas there was no change in mean transmitral pressure gradient by Doppler echocardiography (5 +/- 2 versus 6 +/- 3 mm Hg, p = NS) and left atrial volume (74 +/- 34 versus 72 +/- 27 cm3, p = NS). Thus, 6 to 11 months after balloon mitral valvuloplasty, mean mitral valve area decreases slightly. Individual changes in valve area, however, are variable. Valvular morphology assessed by two-dimensional echocardiography may be useful for identifying those patients who have an increased likelihood of developing valvular restenosis.     

Mitral balloon valvuloplasty for mitral restenosis after surgical commissurotomy

Mitral balloon valvuloplasty was performed in 14 patients with recurrent mitral stenosis 16.9 +/- 1.8 years (range 6 to 30) after surgical commissurotomy. There were 13 women and 1 man with a mean age of 55 +/- 4 years (range 23 to 73). Mitral balloon valvuloplasty resulted in an increase in mitral valve area from 0.8 +/- 0.1 to 1.7 +/- 0.2 cm2 (p = 0.001), a decrease in mean mitral diastolic pressure gradient from 15 +/- 2 to 7 +/- 1 mm Hg (p = 0.001) and an increase in cardiac output from 3.4 +/- 0.3 to 3.9 +/- 0.3 liters/min (p = 0.03). No deaths, strokes, vascular complications or conduction abnormalities were observed. Mitral regurgitation developed or increased in severity in seven patients (50%). There was no evidence of significant left to right shunt through the atrial septal puncture site after mitral balloon valvuloplasty. A good result (defined as a mitral valve area greater than 1.0 cm2, an increase in mitral valve area greater than 25% and a mean gradient less than 10 mm Hg) was achieved in 9 (64%) of the 14 patients. A subgroup of four patients who had a superior result (increase in mitral valve area of 1.7 +/- 0.2 versus 0.5 +/- 0.1 cm2 in the other 10 patients, p = 0.004) was identified. These patients had less echocardiographic evidence of rheumatic mitral valve damage and were the only patients who had sinus rhythm. They were also younger, less debilitated and had a lower grade of fluoroscopic valve calcification compared with the other patients. Thus, mitral balloon valvuloplasty is a safe and effective procedure for patients with recurrent mitral stenosis after surgical commissurotomy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Balloon mitral valvotomy after surgical commissurotomy: clinical and hemodynamic results of a large, single-center study

BACKGROUND AND AIM OF THE STUDY: Patients with restenosis after open or closed surgical commissurotomy (SC) often demonstrate more severe valve degeneration than patients without prior surgery. This may affect the result of balloon mitral valvotomy (BMV) in this patient group. METHODS: The immediate- and long-term results (maximum 106 months; mean 26 months) of BMV with the Inoue balloon in patients with prior SC were compared with findings in patients without prior surgery. Between February 1989 and July 2001, a total of 1,156 BMV interventions was performed, of which 127 were conducted in patients (106 women, 21 men; mean age 56 +/- 12 years) with prior SC. RESULTS: After BMV, the mitral valve area (MVA) increased from 1.0 +/- 0.2 cm2 to 1.6 +/- 0.4 cm2 after SC compared with 1.0 +/- 0.3 cm2 to 1.8 +/- 0.4 cm2 without SC. After three months, the average MVA was 1.7 +/- 0.3 cm2 in both patient groups. The mean NYHA class improved from 2.8 to 2.0 (after SC) versus 2.7 to 1.8 (no SC) three months after BMV. The main complications were cardiac tamponade in three patients (2.4 %), and more than moderate mitral regurgitation (grade 2+) in six (4.7 %) compared to 5.8% in no-SC patients. CONCLUSION: In view of the satisfactory clinical and hemodynamic results, BMV with the Inoue balloon can be considered the treatment of choice for mitral valve restenosis after SC in selected patients.     

Usefulness of echocardiography in the prediction of early results of catheter balloon mitral valvuloplasty

Catheter balloon mitral valvuloplasty (BMV) was performed in 50 patients and 32 of them undergoing BMV with double balloon technique were studied to evaluate the usefulness of echocardiography in the prediction of early results of BMV. Five echocardiographic variables including mitral valve motion, mitral valve thickness, subvalvular change, commissural calcification and left atrial dimension were evaluated. Each variable was divided into mild, moderate and severe subgroups. Before valvuloplasty there were no differences in mitral valve area among any subgroup for any variable. After valvuloplasty, variables associated with a greater increase in mitral valve area from mild and moderate subgroups than from severe subgroup included mitral valve motion, mitral valve thickness, and subvalvular change, but not commissural calcification or left atrial dimension. We scored the former 3 variables as 0, 1 and 2 points in the mild, moderate and severe subgroups, respectively. The sums of individual scores in these 3 variables were further divided into 3 groups: 12 patients had a lower score (less than 2), 10 patients had a score of 3-4 and 10 patients had a higher score (greater than 5). Patients with lower scores tended to have greater increases in mitral valve areas after valvuloplasty than those with higher scores. Thus, mitral valve motion, mitral valve thickness and subvalvular change may be useful to predict a greater increase in mitral valve area after valvuloplasty. A lower score of echocardiographic variables anticipates successful balloon mitral valvuloplasty, which may be helpful in patient selection.     

Mitral valve resistance as a hemodynamic indicator in mitral stenosis.

Variability of the valve area calculated by the Gorlin formula has been noted in bioprosthetic and aortic valves, but few data are available for native stenotic mitral valves. Valve resistance has been proposed as an alternative hemodynamic indicator; however, its value in mitral stenosis has not been assessed. Thirty-four patients had simultaneous recordings of left atrial and ventricular pressures, 26 after percutaneous balloon mitral dilatation (PBMD). Patients with shunt or mitral regurgitation were excluded. Mitral valve resistance correlated exponentially with Gorlin mitral area (y = 133*[area]-1.5; p less than 0.0001). Both Gorlin mitral area and mitral resistance improved after PBMD (0.89 +/- 0.07 cm2 to 2.22 +/- 0.15 cm2; p less than 0.001; and 166 +/- 20 to 40 +/- 8 dynes.s.cm-5; p less than 0.001). Gorlin area and mitral resistance correlated with New York Heart Association functional class. After infusion of isoproterenol in 17 patients, there was an increase in Gorlin area (baseline 1.77 +/- 0.22 cm2, change 0.23 +/- 0.10; p less than 0.03), whereas mitral resistance did not change (baseline 96 +/- 16 dynes.s.cm-5, change 2 +/- 5; p = not significant). Mitral resistance is valuable in the assessment of mitral stenosis. It varies less than Gorlin mitral area under changing hemodynamic conditions.     

Mitral regurgitation after percutaneous balloon mitral valvuloplasty in adults: evaluation by pulsed Doppler echocardiography

Percutaneous balloon mitral valvuloplasty is a new technique used in the treatment of adult patients with mitral stenosis. To evaluate the occurrence and severity of mitral regurgitation after balloon valvuloplasty, 24 patients (20 women and 4 men, mean age 57 years) were studied using two-dimensional and Doppler echocardiography before and less than 24 h after this procedure. Mitral valve area increased after valvuloplasty in all patients, from 0.89 +/- 0.07 to 1.61 +/- 0.09 cm2 (p less than 0.001). Before valvuloplasty, 10 patients had no mitral regurgitation, 4 had 1+, 4 had 2+ and 6 had 3+ mitral regurgitation. After valvuloplasty, new mitral regurgitation occurred in six patients. Regurgitation grade did not change in 13 patients (54%), increased by one grade in 8 patients (33%) and by two grades in 3 patients (13%). Left atrial volume decreased in all except one patient from 100 +/- 12 to 83 +/- 12 cm3 (p less than 0.001). Neither age, sex, cardiac rhythm, initial mitral valve area, increase in mitral valve area, morphologic characteristics of the valvular and subvalvular apparatus, previous mitral commissurotomy nor effective balloon dilating area discriminated between those patients with and without an increase in mitral regurgitation after valvuloplasty. Thus, mitral balloon valvuloplasty is frequently associated with an increase in mitral regurgitation. However, in this series, no patient developed severe mitral regurgitation, and left atrial volume decreased in nearly all patients. An increase in mitral regurgitation could not be predicted from any features of the valve or subvalvular apparatus, clinical characteristics of the patients or technical aspects of the procedure.     

Follow-up of patients undergoing percutaneous mitral balloon valvotomy. Analysis of factors determining restenosis

This study reports the clinical follow-up (13 +/- 1 months) of 100 consecutive patients who underwent percutaneous mitral balloon valvotomy (PMV). Echocardiographic (n = 32) and cardiac catheterization (n = 37) data from this group are also included. Patients were divided into two groups by an echocardiographic score. PMV resulted in a good hemodynamic result (post-PMV mitral valve area, greater than or equal to 1.5 cm2) in 88% of patients with a score of 8 or less and 44% of patients with a score of more than 8. Eighty-eight percent of patients with a score of 8 or less (n = 57) were New York Heart Association (NYHA) functional Classes III and IV before PMV; at follow-up, 81% were NYHA Class I and 12% were NYHA Class II. There were no deaths; three patients underwent mitral valve replacement (MVR). Ninety-eight percent of patients with a score of more than 8 (n = 43) were NYHA Classes III and IV before PMV; at follow-up, 58% were NYHA Classes I and II. Seven patients who did not improve and were not surgical candidates died 3.8 +/- 1.2 months after PMV. Nine patients who were surgical candidates underwent elective MVR at 4 +/- 0.9 months after PMV. Repeat cardiac catheterization demonstrated restenosis in only one of 27 patients (4%) with a score of 8 or less. Mitral valve area after PMV was 1.9 +/- 0.1 cm2 and at follow-up was 2 +/- 0.1 cm2 (NS).(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors influencing progression of mitral regurgitation after transarterial balloon valvuloplasty for mitral stenosis

This study analyzes the clinical, echocardiographic and hemodynamic factors affecting progression of mitral regurgitation (MR) after transarterial balloon valvuloplasty in 200 consecutive patients with rheumatic mitral stenosis. After valvuloplasty, the mitral valve area increased in all patients, from 1.03 +/- 0.36 to 2.06 +/- 0.71 cm2 (p less than 0.0001). With regard to the basal stage, the mitral valve was competent in 139 patients and there was mild MR in 61 (grade I in 53, and grade II in 8). Three patients had progression of MR induced by a technical deficiency and they were excluded from analysis. Patients were classified into 2 groups on the basis of the degree of MR before and after valvuloplasty: group A--no progression of MR (n = 167; 85%) when the degree of MR did not change, disappeared after valvuloplasty, or increased from grade 0 to I; group B--progression of MR (n = 30; 15%) when the degree of MR increased to greater than or equal to grade II. Progression of MR was observed more frequently in older patients with presence of chronic atrial fibrillation, larger left atrial size and left ventricular volumes, baseline MR, more severe stenosis and a lower ejection fraction. Multivariate analysis selected age, left ventricular volumes and ejection fraction as independent predictors of progression of MR. All these factors suggest that progression of MR after balloon valvuloplasty could be related to a more advanced degree of disease.     

The double-balloon and Inoue techniques in percutaneous mitral valvuloplasty: comparative results in a series of 232 cases

Immediate hemodynamic results of percutaneous mitral valvuloplasty were compared in two consecutive series of unselected patients from the same institution undergoing valvuloplasty with the double-balloon (161 patients) or the Inoue balloon (71 patients) technique. Before valvuloplasty, the patient series were comparable with regard to average age, gender repartition and most clinical, electrocardiographic, X-ray and hemodynamic variables. Poor anatomic forms of mitral stenosis were equally distributed in both series (41% vs. 45%, p = NS). The magnitude of mitral valve area increase and of mean mitral gradient decrease during percutaneous mitral valvuloplasty did not differ significantly in the Inoue balloon and double-balloon series (mean +/- SEM 1.1 +/- 0.2 to 1.95 +/- 0.5 and 1.0 +/- 0.2 to 1.97 +/- 0.5 cm2, respectively, for mitral valve area and 12 +/- 3 to 5 +/- 2 and 13 +/- 4 to 5 +/- 2 mm Hg, respectively, for mean mitral gradient). Four cases of 3+ mitral regurgitation occurred in the Inoue balloon series and 7 in the double-balloon series (p = NS). A good immediate result--defined as mitral valve area greater than or equal to 1.5 cm2 with greater than or equal to 25% in mitral valve area gain and mitral regurgitation less than 2+ at the end of the procedure--was observed in 78% of patients in both series. Three cases of tamponade due to chamber perforation and 14 cases of transient air embolism in the right coronary system due to balloon rupture were observed in the double-balloon series.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prospective study of mitral valve repair with the CarboMedics AnnuloFlex annuloplasty system: effectiveness and safety after one year

BACKGROUND AND AIM OF THE STUDY: The CarboMedics AnnuloFlex annuloplasty system includes a flexible ring that may be implanted as a complete or partial ring to correct mitral annular dilatation by reinforcement of the entire annulus, or only the posterior portion of the annulus. The study aim was to evaluate clinical and functional results during the first year in patients receiving this flexible annuloplasty system. METHODS: Between February 2001 and August 2002, 69 patients (mean age 55 years; range: 27-81 years) underwent mitral valve repair that included implant of the AnnuloFlex annuloplasty ring. Mitral regurgitation (MR) was the predominant lesion, with 98.6% of patients exhibiting grade 3/4 insufficiency. Functional classification of valve pathology was normal leaflet motion (type I) in 4% of patients, leaflet prolapse (type II) in 93%, and restricted leaflet motion (type III) in 3%. Valve disease was degenerative in 90%, ischemic in 4%, infectious in 3%, and other in 3%. RESULTS: There was one hospital death. Late follow up was obtained for 62 patients; cumulative follow up was 61 patient-years. One-year actuarial survival was 99%, freedom from thromboembolism was 94%, from endocarditis 98%, and from reoperation 98%. Echocardiographic evaluations performed at 3-6 months after repair (mean 4.7 months) showed MR to be grade 0/1+ in 90% of patients and grade 2+ in 8%. Mitral valve area was 3.4+/-1.7 cm2, within normal limits (mitral valve area > or =1.5 cm2) in 95% of patients. Average peak and mean pressure gradients were 5.9+/-3.0 and 2.8+/-1.7 mmHg, respectively. Left ventricular end-diastolic diameter decreased postoperatively, which may reflect successful correction of MR after mitral valve repair. CONCLUSION: These early results show that the AnnuloFlex annuloplasty system is safe and effective when used with other techniques for repair of MR, and preserves mitral annular flexibility and function at one-year follow up.     

Comparison of early results of percutaneous metallic mitral commissurotome with Inoue balloon technique in patients with high mitral echocardiographic scores.

We compared the safety, efficacy, and cost of the newly introduced percutaneous metallic commissurotome (PMC) with the results of Inoue balloon mitral valvuloplasty (BMV) in 80 patients with mitral stenosis (MS). The mean increase in mitral valve area (MVA) was 0.95 +/- 0.19 to 1.7 +/- 0.35 cm(2) for PMC and 0.97 +/- 0.15 to 1.81 +/- 0.36 cm(2) for BMV (P = NS). The Wilkins echocardiographic scores before dilatation did not correlate with any difference in MVA after dilatation. Bilateral commissural splitting was significantly more common with PMC than with BMV (30/39 patients, 76.9%, vs. 21/40 patients, 52.5%; P = 0.02). Postprocedural severe mitral regurgitation occurred in 1/39 (2.6%) in the PMC group and in 4/41 (9.8%) in the BMV group. Because the PMC device is resterilizable, we estimated the cost to be one-fourth the cost of BMV with the Inoue balloon. The estimated device cost ratio of PMC to BMV for each patient was 1 to 4.25. The early results of PMC on the MVA are comparable to BMV. However, PMC had better results not only in patients with high echocardiographic scores, but the PMC device splits commissural calcification better than BMV.     

Percutaneous balloon valvotomy for patients with severe mitral stenosis

Thirty-five patients with severe mitral stenosis underwent percutaneous mitral valvotomy (PMV). There were 29 female and six male patients (mean age 49 +/- 3 years, range 13 to 87). After transseptal left heart catheterization, PMV was performed with either a single- (20 patients) or double- (14 patients) balloon dilating catheter. Hemodynamic and left ventriculographic findings were evaluated before and after PMV. There was one death. Mitral regurgitation developed or increased in severity in 15 patients (43%). One patient developed complete heart block requiring a permanent pacemaker. PMV resulted in a significant decrease in mitral gradient from 18 +/- 1 to 7 +/- 1 mm Hg (p less than .0001) and a significant increase in both cardiac output from 3.9 +/- 0.2 to 4.6 +/- 0.2 liters/min (p less than .001) and in mitral valve area from 0.8 +/- 0.1 to 1.7 +/- 0.2 cm2 (p less than .0001) Effective balloon dilating diameter per square meter of body surface area correlated significantly with the decrease in mitral gradient but did not correlate with the degree of mitral regurgitation. There was no correlation of age, prior mitral commissurotomy or mitral calcification with hemodynamic results. PMV is an effective nonsurgical procedure for patients with mitral stenosis, including those with pliable valves, those with previous commissurotomy, and even those with mitral calcification.     

Outcomes of balloon mitral valvuloplasty for rheumatic mitral stenosis during pregnancy

Background Rheumatic mitral stenosis is the most common acquired valvular heart disease encountered during pregnancy. Balloon mitral valvuloplasty(BMV)is one of the treatment options if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. Prospective studies on BMV and its effect on pregnancy outcomes and neonates are needed. Methods All pregnant women with severe symptomatic isolated mitral stenosis who underwent elective BMV in our institute from January 2000 to December 2018 were analyzed retrospectively. Clinical,haemodynamic and echocardiographic outcomes immediately after the procedure were analyzed. Results This study involved twenty-seven pregnant women in whom BMV was performed. The procedure was successful in 26 patients(96.29%). There were significant changes after BMV in the measured 2 D MVA,pulmonary arterial systolic pressure and the mean left atrial pressure(P0.01). Post-procedure follow-up showed an improvement in NYHA status by at least one class in 85.19%(25/27)patients. In the cases of mitral valve regurgitation,the area of mitral valve regurgitation increased significantly after the procedure(P0.01). Four(19.05%)patients had a full-term normal vaginal delivery and seventeen(80.95%)underwent cesarean section for obstetric indications. Five patients had abortions after the procedure. After the procedure,only one patient had severe mitral regurgitation after the procedure and nine patients had moderate mitral regurgitation,and the rest had either no mitral regurgitation or mild mitral regurgitation. Symptomatic improvement was noted in all of the patients with on maternal and fetal complications except one case of mortality. Conclusion Percutaneous BMV is safe and effective in providing excellent symptomatic relief and hemodynamic improvement for pregnant patients with mitral stenosis.[S Chin J Cardiol 2019;20(2):63-68]     

Single balloon valvotomy for rheumatic mitral restenosis

Four male patients aged 22 to 35 years (mean 29 +/- 5.6) with mitral restenosis following closed mitral valvotomy 6 to 12 years (mean 8.5 +/- 2.5) ago were subjected to percutaneous single balloon valvotomy. There was significant increase in the area of the mitral valve accompanied by a substantial reduction in the transmitral gradient (P less than 0.01). Mitral regurgitation of grade +1 developed in one patient. Balloon valvotomy may be safely and effectively performed in selected patients with mitral restenosis after surgical commissurotomy.     

Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis. A prospective, randomized trial

BACKGROUND. We performed a prospective, randomized trial comparing percutaneous balloon commissurotomy with surgical closed commissurotomy in 40 patients with severe rheumatic mitral stenosis. METHODS AND RESULTS. Data were analyzed by investigators who were masked to treatment assignment or phase of study. Patients randomized to balloon (n = 20) or surgical (n = 20) commissurotomy had severe mitral stenosis without significant baseline differences (left atrial pressure, 26.1 +/- 4.2 versus 27.6 +/- 6.2 mm Hg; mitral valve gradient, 18.0 +/- 4.2 versus 19.7 +/- 6.3 mm Hg; mitral valve area, 1.0 +/- 0.2 versus 1.0 +/- 0.4 cm2, respectively). At 1-week follow-up after balloon commissurotomy, pulmonary wedge pressure was 14.3 +/- 7.2 mm Hg; mitral valve gradient was 9.6 +/- 5.1 mm Hg; and mitral valve area was 1.6 +/- 0.6 cm2 (all p less than 0.0001). At 1-week follow-up after surgical closed commissurotomy, wedge pressure was 13.7 +/- 5.4 mm Hg; mitral valve gradient was 9.4 +/- 4.2 mm Hg (both p less than 0.0001); and mitral valve area was 1.6 +/- 0.7 cm2 (p less than 0.003). At 8-month follow-up, improvement occurred in both groups: Mitral valve area was 1.6 +/- 0.6 cm2 in the balloon commissurotomy group (p less than 0.002) and was 1.8 +/- 0.6 cm2 in the surgical closed commissurotomy group (p less than 0.0001). There was no difference between the groups at 1-week or 8-month follow-up (all p greater than 0.4). One case of severe mitral regurgitation occurred in each group; complications were otherwise related to transseptal catheterization. There was no death, stroke, or myocardial infarction. Cost analysis revealed that balloon commissurotomy may substantially exceed the cost of surgical commissurotomy in developing countries, whereas it may represent a significant savings in industrialized nations. CONCLUSIONS. We conclude that percutaneous balloon commissurotomy and surgical closed commissurotomy result in comparable hemodynamic improvement that is sustained through 8 months of follow-up.     

Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 219 patients with symptomatic, severe rheumatic mitral stenosis. There were 59 men and 160 women, aged 19 to 76 years (mean 43). Pliable, noncalcified valves were present in 139 (group 1), and calcified valves or severe mitral subvalvular lesions, or both, in 80 patients (group 2). Atrial fibrillation was present in 133 patients (61%) and 1+ or 2+ mitral regurgitation in 59 (27%). Technical failure occurred with 3 patients in our early experience. There was no cardiac tamponade or emergency surgery. The only in-hospital death occurred 3 days after the procedure in a group 2 premoribund patient in whom last-resort PTMC created 3+ mitral regurgitation. Mitral regurgitation appeared or increased in 72 patients (33%); 3+ mitral regurgitation resulted in 12 patients (6%). There were 3 systemic embolisms. Atrial left-to-right shunts measured by oximetry developed in 33 patients (15%). Immediately after PTMC, there were significantly reduced (p = 0.0001) left atrial pressure (24.2 +/- 5.6 to 15.1 +/- 5.1 mm Hg), mean pulmonary artery pressure (39.7 +/- 13.0 to 30.6 +/- 10.9 mm Hg) and mitral valve gradient (13.0 +/- 5.1 to 5.7 +/- 2.6 mm Hg). Mitral valve area increased from 1.0 +/- 0.3 to 2.0 +/- 0.7 cm2 (p = 0.0001) and cardiac output from 4.4 +/- 1.4 to 4.7 +/- 1.2 liters/min (p less than 0.01). The results mirrored clinical improvements in 209 patients (97%). Multivariate analysis showed an echo score greater than 8, and valvular calcification and severe subvalvular lesions as independent predictors for suboptimal hemodynamic results.(ABSTRACT TRUNCATED AT 250 WORDS)