Abstract
Abstract Background The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. Methods We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. Results Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p=0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p=0.02, p=0.02, p=0.001, p=0.01, p=0.02, and p=0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p=0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score >8, post-procedural MR of ≥2, and post-procedural MVA <1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p<.0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA <1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P<.0001) Conclusion Our research reveals trends over time in patients' characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score >8, post-procedural MR of ≥2, and post-procedural MVA <1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization. Funding Acknowledgement Type of funding sources: None.
Highlights
Rheumatic heart disease (RHD) is a serious cardiac complication of an immune-mediated infectious disease known as rheumatic fever that is caused by Streptococcus pyogenes infection in childhood
Wilkins score and all its components increased over time, which was higher in females (p=0.01), and was not correlated with age (p=0.95)
There was a significant increase in the rates of male patients, smoking, dyslipidemia, and chronic kidney disease, this remained true after adjusting for age (p = 0.02, p = 0.001, p = 0.02 and p = 0.001, respectively)
Summary
Rheumatic heart disease (RHD) is a serious cardiac complication of an immune-mediated infectious disease known as rheumatic fever that is caused by Streptococcus pyogenes infection in childhood. The most prominent late manifestation of RHD is valvular dysfunction, which primarily affects the mitral and aortic valves. Percutaneous balloon mitral valvuloplasty (PBMV) was first introduced in the early 1980s by Kanji Inoue, a Japanese surgeon. He conceived the idea that a narrowed pliable valve could be expanded by splitting the valve commissures using a balloon inflated with high pressure. Percutaneous balloon mitral valvuloplasty (PBMV) is the current standard of care for selected patients with rheumatic mitral stenosis. We examined trends in patient demographics, Wilkins score and additional echocardiographic characteristics, success rates, and complications over a 30-year period
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