Echocardiographic Long‐Term Evaluation of Percutaneous Balloon Mitral Valvotomy

Abstract

Percutaneous balloon mitral valvotomy (BMV) is an alternative therapeutic method for patients with mitral stenosis. We studied 62 patients (56 females, mean age 36.4 years) who underwent balloon mitral valvotomy. Five patients were pregnant and in New York Heart Association Functional Class IV. Doppler echocardiographic studies were performed prior to the procedure, and at 7 days, 6 months, 12 months, and 24 months after the procedure. We studied the following parameters: echo-score by the sum of valvular mobility, thickening, and calcification, and subvalvular disease, graded from 1 to 4; and mitral valve area (MVA) and mitral pressure gradient (MPG) by Doppler echocardiography. The patients were separated into two groups: group I with an echo-score less than or equal to 8 (40 patients), and group II with an echo-score greater than or equal to 9 (22 patients). Mitral valve area and MPG were compared with hemodynamics through the correlation coefficient and linear regression. Comparison between groups I and II was performed using the unpaired Student's t-test. Follow-up of MVA and MPG was analyzed by analysis of variance. The Student's t-test did not show any significant difference between MVA and MPG before balloon mitral valvotomy. There was significant decrease of MVA in group II (P less than 0.01) in the last three studies. There was significant increase in MPG in group II (P less than 0.01) in every postvalvotomy study. The analysis of variance of group I showed statistical increase of the MVA, and significant decrease of the MPG after BMV. The analysis of variance of group II showed significant increase in MVA and significant decrease in MPG between the pre- and the first postvalvotomy study. There was significant decrease (P less than 0.01) in MVA, and increase in MPG in the three postvalvotomy studies. Complications included mitral regurgitation, residual interatrial communication, pericardial effusion due to an atrial wall perforation, and peripheral embolization. Atrial fibrillation did not significantly alter the results of BMV. Results were considered positive when MVA was greater than 1.5 cm 2 and area increase was greater than 25%. Patients with an echo-score less than or equal to 8 (group I) benefit from BMV, with a positive predictive value greater than 78%. In pregnant patients the symptomatology was alleviated by BMV, without any signs of fetal compromise.

Can a Novel Echocardiographic Score Better Predict Outcome after Percutaneous Balloon Mitral Valvuloplasty?

“…Many recently reported series stressed the importance of commissural morphology (chiefly commissural calcification) in determining outcome of PBMV [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][27][28][29][30][31][32] and demonstrated commissural splitting as the pivotal mechanism by which MVA is increased during the procedure 17,28 (Fig. 2).…”

“… The Massachusetts General Hospital (MGH) scoring system (total score expressed out of 16) 16,24 that includes scoring values for MV leaflet thickness (0–4), mobility restriction (0–4), calcification (0–4) and subvalvular affection (0–4), each expressed out of 4. The novel scoring system that includes: …”

“…12,13 Early echocardiographic scores for assessment of eligibility for PBMV employed semiquantitative evaluation of leaflet thickness, mobility, calcification, and subvalvular involvement. [14][15][16] However, these scores were chiefly derived from transthoracic echocardiographic assessment performed in younger individuals and their validity has been questioned. 1 It is widely accepted now that clinical and procedural outcome can be predicted from prudent Vol.…”