Echocardiographic factors determining immediate results of percutaneous mitral balloon commissurotomy

Abstract

Define echocardiographic predictors of the immediate results of percutaneous mitral balloon commissurotomy (PMC) PMC by the Inoue balloon was attempted in 247 patients (mean age: 35 ans, 77% female) with severe mitral valve stenosis. All the patients had undergone echocardiographic examination before PMC to assess mitral anatomy, commissural calcification and to determine the Wilkins score. The mean value of Wilkins score was 7,98 ± 1,61(range 5–13) and the mean mitral valve area (MVA) before PMC was 1 ± 0,19 cm 2 (range 0,5–1,4 cm 2 ). Twenty-nine patients (11,7%) had one-commissural calcification. After PMC, the mean MVA increased to 1,79 ± 0,34 cm 2 ( P < 0,001) resulting in a success rate of 83%. Severe mitral regurgitation (MR) occured in 5 patients (2%). Wilkins score was an independent predictor of the immediate result of PMC, but if > 8, this score had a weak predictive value. Commissural morphology was another independent predictor of the immediate result of PMC. Echocardiography is now the cornerstone in the assessment of mitral anatomy before PMC and should integrate Wilkins score and commissural morphology for the optimal selection of patients to PMC.