Long-term, Clinical and Echocardiographic Results After Successful Mitral Balloon Valvotomy and Predictors of Long-term Outcome

Fawzy, Mohamed; Hegazy, Hesham; Shoukri, Mohamed

doi:10.1016/j.accreview.2005.11.034

Cited by 18 publications

(31 citation statements)

References 17 publications

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“…The most commonly reported independent predictors of post-PMV clinical events (cardiovascular death, mitral valve surgery and repeat PMV) and restenosis are echo score and post-PMV MVA, both related to mitral valve anatomy. 2,6,7,12,23 However, our results are in agreement with similar studies that also identified mPAP as an independent predictor of event-free survival. 2,6 Differences in the definition of endpoints and in baseline population characteristics may explain the different predictors reported in the literature.…”

Section: Discussionsupporting

confidence: 79%

“…Os doentes que necessitaram de reintervenção mitral durante o seguimento clínico eram mais novos (43,3 vs. 51,2 anos, p = 0,04), tinham gradientes transmitrais pré e pós-PMV mais elevados (14,9 vs. 11,5 mmHg, p = 0,02 e 6,4 vs. 2,1 mmHg, p < 0,001) e uma pressão média na artéria pulmonar (mPAP) pós-PMV mais elevada (30,0 vs. 23,2 mmHg, p = 0,01). No modelo de regressão logística de Cox a mPAP ≥ 25 mmHg foi o único preditor de reintervenção mitral (HR 5,639 [1,5], p = 0,025) e de eventos clínicos (HR 3,6 [1,(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)3], p = 0,039). Conclusão: Na população estudada, a mPAP medida imediatamente após a valvuloplastia mitral foi o único preditor de reintervenção mitral.…”

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Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

Jorge

Baptista

Faria

et al. 2012

Revista Portuguesa de Cardiologia (English Edition)

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Introduction and aim: Percutaneous mitral valvuloplasty (PMV) is an effective treatment option for mitral stenosis (MS), but its success is assessed on the basis of clinical and echocardiographic outcomes in studies with relatively short follow-up. We aimed to characterize a cohort of patients undergoing PMV with long-term follow-up and to determine independent predictors of post-PMV mitral re-intervention and event-free survival. Methods: We studied 91 consecutive patients with MS who underwent PMV with a median clinical follow-up duration of 99 months. Two endpoints were considered: post-PMV mitral re-intervention (PMV or mitral surgery) and a composite clinical events endpoint including cardiovascular death, mitral valve re-intervention and hospital admission due to decompensated heart failure. We compared patients who required post-PMV mitral re-intervention with those who did not during follow-up. Results: The study population included 83.5% females and mean age was 48.9 ± 13.9 years. The 1-, 3-, 5-, 7-and 9-year rates of clinical event-free survival were 93.0 ± 2.8%, 86.0 ± 3.9%, 81.0 ± 4.4%, 70.6 ± 5.6%, and 68.4 ± 5.8%, respectively. The 1-, 3-, 5-, 7-and 9-year rates of mitral re-intervention-free survival were 98.8 ± 1.2%, 97.5 ± 1.7%, 92.1 ± 3.1%, 85.5 ± 4.5%, and 85.5 ± 4.5%, respectively. The median time to mitral re-intervention was 6.2 years. Patients who required mitral re-intervention during follow-up were younger (43.3 vs. 51.2 years, p=0.04) and had higher pre-and post-PMV mitral gradient (14.9 vs. 11.5 mmHg, p=0.02 and 6.4 vs. 2.1 mmHg, p<0.001) and higher post-PMV mean pulmonary artery pressure (mPAP) (30.0 vs. 23.2 mmHg, p=0.01). In a Cox proportional hazards model, mPAP ≥25 mmHg was the sole predictor of both mitral re-intervention .528], p=0.025) and clinical events .260], p=0.039). PALAVRAS-CHAVEEstenose mitral; Valvuloplastia mitral percutânea; Prognóstico; Pressão média na artéria pulmonar A pressão média na artéria pulmonar após a valvuloplastia mitral percutânea é um preditor de mau prognóstico a longo prazo Resumo Introdução e objetivos: A valvuloplastia mitral percutânea (PMV) é uma opção eficaz para o tratamento da estenose mitral. Contudo, os resultados deste procedimento são baseados em estudos clínicos e ecocardiográficos com tempos de seguimento relativamente curtos. Os objetivos deste estudo são caracterizar uma população de doentes submetidos a PMV, realizar um seguimento clínico de longa duração e determinar os preditores independentes de reintervenção mitral após PMV e de sobrevida livre de eventos. Métodos: Foi estudada uma população de 91 doentes com estenose mitral tratada por PMV e realizou-se um seguimento clínico com a duração média de 99 meses. Foram pré-definidos dois endpoints: reintervenção mitral pós-PMV (PMV ou cirurgia mitral) e um endpoint clínico combinado que incluiu morte de causa cardiovascular, reintervenção mitral e internamento hospitalar por insuficiência cardíaca descompensada. Foi realizado um estudo comparativo entre os doentes que necessi...

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Section: Discussionsupporting

confidence: 79%

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Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

Jorge

Baptista

Faria

et al. 2012

Revista Portuguesa de Cardiologia (English Edition)

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“…tarafından literatüre tanıtılan PMBV günümüzde semptomatik ve mitral kapak morfolojisi uygun olan MD hastalarında komissürotomi veya kapak replasmanına alternatif güvenilir bir tedavi seçeneği haline gelmiştir [1,5,14]. Daha önce yapılan büyük ölçekli çalışmalarda PMBV'nin kısa ve uzun dönem etkili semptomatik ve hemodinamik iyileşme gösterdiği bildirilmiştir [6,8,10,11].…”

Section: Discussionunclassified

Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience

Yıldız¹

2014

Diclemedj

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Objective: We sought to analyze short-term clinical, echocardiographic, and hemodynamic consequences of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of rheumatic mitral stenosis (MS) in our clinic. Methods:We retrospectively reviewed 53 patients (49 females, 5 males; mean age 38±11 years) who underwent PMBV for moderate or severe MS between January 2010 and October 2014. Procedural success was defined as the reaching a mitral valve area (MVA) >1.5 cm 2 and absence of grade 3 mitral regurgitation. Results:We were able to perform PMBV in 48 of 53 patients (91%) and all the procedures that were completed were successful. PMBV couldn't be performed in 3 patients due to inability to pass the mitral valve, 1 patient due to membranous obstructive vena cava and 1 patient due inability to perform septostomi. Two patients who underwent successful PMBV became symptomatic after an average of 14 months follow-up and mitral valve replacement was performed due to moderate-to-severe MS. Patients were followed for an average of 13 ± 8 months and atrial fibrillation development or embolic complications were not observed. Conclusion:Percutaneous mitral balloon valvuloplasty procedure is a safe and effective treatment approach with high success and low complication rates in experienced centers.Key words: Mitral stenosis, percutaneous mitral balloon valvuloplasty, echocardiography, mitral valve area ÖZET Amaç: Bu çalışmada kliniğimizdeki romatizmal mitral darlıklı (MD) erişkin hastalara uygulanan perkütan mitral balon valvüloplastinin (PMBV) erken dönem klinik, ekokardiyografik ve hemodinamik sonuçlarını değerlendirme-yi amaçladık.Yöntemler: Kliniğimizde Ocak 2010-Ekim 2014 tarihleri arasında orta ya da ciddi MD nedeniyle PMBV uygulanan 53 hasta (49 kadın, 5 erkek; ortalama yaş 38±11 yıl) geriye dönük olarak değerlendirildi. İşlem başarısı, işlem sonrası mitral kapak alanının (MKA) >1,5 cm 2 olması ve 3. derece mitral yetersizlik (MY) olmaması olarak kabul edildi. Bulgular:Toplam 53 hastadan 48'inde (%91) PMBV iş-lemi uygulanabildi ve tamamlanabilen tüm işlemler başarılı oldu. Hastalardan 3'üne kapak geçilememesi, 1'ine membranöz obstrüktif vena kava, 1'ine de septostomi yapılamaması nedeniyle PMBV uygulanamadı. Başarılı PMBV uygulanan 2 hastaya ortalama 14 ay sonra semptomatik orta-ciddi MD nedeniyle mitral kapak replasmanı yapıldı. Ortalama 13±8 ay boyunca izlenen hastalarda atrial fibrilasyon gelişmesi veya embolik komplikasyonlar izlenmedi.Sonuç: Perkütan mitral balon valvüloplasti işlemi deneyimli merkezlerde yüksek başarı ve düşük komplikasyon oranları ile etkin ve güvenli bir tedavi yaklaşımıdır.Anahtar kelimeler: Mitral darlık, perkütan mitral balon valvüloplasti, ekokardiyografi, mitral kapak alanı

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“…15,16 Exclusion criteria included: i.Documented history or peri-procedural` occurrence of AF or any other sustained arrhythmia. ii.…”

Section: Methodsmentioning

confidence: 99%

“…2,28 Immediately after the BMV procedure a repeat echocardiogram was performed to define the success of procedure as mentioned previously. 15,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] All patients, in whom BMV was successful, underwent a repeat echocardiographic evaluation 24-48 hours after the procedure for the measurement of post-procedural parameters.…”

Section: Echocardiographymentioning

confidence: 99%

Acute Impact of Balloon Mitral Valvotomy on Left Atrial Functions in Mitral Stenosis

Beig¹,

Dar²,

Kumar³

et al. 2017

JCDR

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Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atrial (LA) mechanical functions. This study was conducted to assess the acute impact of Balloon Mitral Valvotomy (BMV) on these functions. Methods: This single centre observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area of 0.74 ± 0.13 cm²), in sinus rhythm, who underwent successful BMV at our hospital. Phasic LA volumes (V max : maximal LA volume, V min : minimal LA volume, and V p : LA volume at the onset of P-wave) were measured by modified Simpson's method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from these volumes. All these parameters were evaluated before and 24-48 hours after BMV. Results: Successful BMV led to significant reduction in V max (p < 0.001), V min (p < 0.001), and V p (p < 0.001). There was a significant increase in LATEF (p= 0.001) and LAEI (p= 0.002). LAPEF increased insignificantly (p= 0.057), while there was no significant change in LAAEF (p =0.127) after BMV. Conclusion: Successful BMV leads to early improvement in left atrial reservoir and conduit functions, without significantly affecting left atrial pump function. Whether these acute changes translate into long term left atrial reverse remodelling and clinical benefits thereof needs to be established by further studies.

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Long-term, Clinical and Echocardiographic Results After Successful Mitral Balloon Valvotomy and Predictors of Long-term Outcome

Cited by 18 publications

References 17 publications

Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience

Acute Impact of Balloon Mitral Valvotomy on Left Atrial Functions in Mitral Stenosis

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