Transoesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy

Sutaria, Nilesh

doi:10.1136/hrt.2004.058297

Cited by 37 publications

(23 citation statements)

References 20 publications

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“…Our echocardiographic classification does not take into account the severity and location of valve calcification, which have been shown to influence late outcome. [31][32][33] Another explanation for the impact of valve anatomy on late results in certain series is that they also included patients with poor immediate results of PMC in the predictive analysis. [5][6][7][8][9][10]12,15 Including poor immediate results leads to overestimation of the predictive value of valve anatomy on late results because valve anatomy is a strong predictor of procedural success.…”

Section: Predictive Factors Of Poor Late Functional Resultsmentioning

confidence: 99%

Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

Bouleti

Iung²,

Laouénan³

et al. 2012

Circulation

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Background— Long-term follow-up after percutaneous mitral commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm 2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P <0.0001), interaction between age and final mitral valve area ( P <0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification ( P <0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation ( P <0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort. Conclusions— Twenty years after percutaneous mitral commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.

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Section: Predictive Factors Of Poor Late Functional Resultsmentioning

confidence: 99%

Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

Bouleti

Iung²,

Laouénan³

et al. 2012

Circulation

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“…Commissural calcification has been associated with poor results of PMC, but the experience and follow-up are limited. [29][30][31] Scoring systems specifically assessing commissural calcification have been proposed to improve the prediction of results of PMC, but they present some weaknesses. First, they rely only on echocardiographic examination that may overestimate the diagnosis of calcification.…”

Section: Limitationsmentioning

confidence: 99%

Relationship Between Valve Calcification and Long-Term Results of Percutaneous Mitral Commissurotomy for Rheumatic Mitral Stenosis

Bouleti

Iung

Himbert

et al. 2014

Circ: Cardiovascular Interventions

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P ercutaneous mitral commissurotomy (PMC) is the reference treatment for mitral stenosis (MS) in patients with favorable valvular anatomy.1,2 Valve calcification is a known predictor of poor results after PMC in both the immediate and long term. [3][4][5][6][7][8] Specific series have shown the feasibility of PMC in patients with calcified valves, but follow-up was most often limited to midterm. [9][10][11] The only study reporting >10-year follow-up analyzed only commissural calcification. 12 Whether patients with calcified valves should be candidates for PMC or be referred for surgery as first-line treatment is still a debated issue. This is of particular importance in Western countries where valve calcification is frequently encountered in rheumatic MS. 13-15The aim of this study is, therefore, to analyze clinical results of PMC according to the presence and extent of valve calcification, with a particular emphasis on long-term results. Methods Study PopulationThe population consisted of 1024 consecutive patients, residing in France, who underwent PMC for rheumatic MS between 1986 and 1995 in our institution. Patients presenting with degenerative calcific MS because of annular and leaflet calcification without commissural fusion were not considered for PMC. To assess the relationship between the presence of valve calcification, as defined by fluoroscopy, and outcome, the overall population was split into calcified and noncalcified groups. Of this cohort, 314 (31%) had valve calcification, whereas 710 patients (69%) had noncalcified valves. Previous cerebral or peripheral embolic event occurred in 119 patients (19%), a mean of 3 years before PMC. The study was approved by the local review committee. Patients gave written informed consent before PMC. MeasurementsEchocardiographic examination was performed on the day preceding PMC and 24 to 48 hours after the procedure by the same experienced Background-Indications of percutaneous mitral commissurotomy (PMC) remain debated in calcific mitral stenosis. We analyzed long-term results of PMC for calcific mitral stenosis and the factors associated with late functional results. Methods and Results-We compared the characteristics and outcome of 314 patients undergoing PMC for calcific mitral stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥1.5 cm 2 with mitral regurgitation ≤2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P<0.001). The hazard ratio for good functional results (survival without cardiovascular death, without mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1-2.9]; P<0.0001) in patients with calcified valves (12±3% at 20 years) relative to the noncalcified group (38±2% at 20 years). In the 251 patients with calcified valves who had good immediate results, 15-year rates of good functional results were ...

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“…Most cardiologists use the Wilkins score. The available scoring systems, particularly Wilkins score, have many limitations [22, 29, 30], including: Echocardiography limited in ability to differentiate nodular fibrosis from calcification.Assessment of commissural involvement is not included or underestimated.Doesn’t account for uneven distribution of pathologic abnormalities.Doesn’t account for relative contribution of each variable (no weighting of variables).Frequent underestimation of subvalvular disease.Doesn’t use results from TEE or 3D echocardiography.…”

Section: Scoring Systems By Two-dimensional Echocardiographymentioning

confidence: 99%

New Scores for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

Soliman

Anwar

Metawei

et al. 2011

Curr Cardiovasc Imaging Rep

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Nonsurgical management of patients with symptomatic mitral valve stenosis has been established as the therapeutic modality of choice for two decades. Catheter-based balloon dilation of the stenotic valvular area has been shown, at least, as effective as surgical interventions. Unfavorable results of catheter-based interventions are largely due to unfavorable morphology of the valve apparatus, particularly leaflets calcification and subvalvular apparatus involvement. A mitral valve score has been proposed in Boston, MA, about two decades ago, based on morphologic assessment of mitral valve apparatus by two-dimensional (2D) echocardiography to predict successful balloon dilation of the mitral valve. Several other scores have been developed in the following years in order to more successfully predict balloon dilatation outcome. However, all those scores were based on 2D echocardiography, which is limited by ability to distinguish calcification and subvalvular involvement. The introduction of new matrix-based ultrasound probe has allowed 3D echocardiography (3DE) to provide more detailed morphologic analysis of mitral valve apparatus including calcification and subvalvular involvement. Recently, a new 3DE scoring system has been proposed by our group, which represents an important leap into refinement of the use of echocardiography guiding mitral valve interventions.

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Transoesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy

Cited by 37 publications

References 20 publications

Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

Relationship Between Valve Calcification and Long-Term Results of Percutaneous Mitral Commissurotomy for Rheumatic Mitral Stenosis

New Scores for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

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