145 Clinical and hemodynamic results of percutaneous mitral valvuloplasty at patients with mitral stenosis and pulmonary artery hypertension

Abstract

The percutaneous balloon mitral valvuloplasty (PBMV) became the procedure of choice of the mitral stenosis with favorable morphology. The development of the pulmonary hypertension (PH) is a frequent in patients with mitral stenosis. However, its influence on results of the PBMV is unknown. To determine the impact of the PH on immediate and long term results of the PBMV. Retrospective study that spreads on 6 years (from 1996 to 2002) regrouping all patients having undergone a PBMV for the first time. Clinics, echographic, hemodynamic data of patients have been collected. 72 patient had a systolic arterial pulmonary pressure (SPP) 60 mmHg (group H) whereas 217 had a SPP <60 mmHg (group N). Group H patients were older, had more acute pulmonary edema at admission, an echographic score >8, tricuspid regurgitation and smaller pre PBMV mitral surface. A bad result was noted in 11.4% in group H against 8.6% in group N (p = 0, 04). Post procedural complications were similar, except for the severe mitral regurgitation, more often frequent in the group H. During a mean follow-up of 92 months, fifty-three patients in group H and 204 patients in group N were free of cardiac events. The NYHA class I or II were met more in the N group. The residual systolic pulmonary pressure was higher in H group. The PBMV is an efficient procedure even in presence of PH in spite of the pejorative character that it confers on the immediate and longterm prognosis.