Follow-Up Assessment after Percutaneous Mitral Valvuloplasty (PMV) with Inoue Balloon

Abstract

Background:Percutaneous Mitral Valvuloplasty (PMV) is the first-line treatment modality in selected patients with symptomatic mitral stenosis and more recently available Inoue single-balloon catheter technique produces good results with low incidence of complications. The purpose of this study was to evaluate the immediate and over 6 months follow-up results after successful PMV with an Inoue balloon and to identify the predictive factors for the results. Methods:From May 1995 to Feburary 1997, a PMV with an Inoue balloon was technically successful in 114 (95%) of the 119 patients treated at the Sejong General Hostpital. In this study, a series of echocardiographic follow-up were performed in 54 patients with rheumatic mitral stenosis, at least 6 months after their successful PMV. In PMV, the inflation was conducted in steps, starting with a recommended maximum size of balloon by the Inoue criteria. After each inflation, the mitral valve opening and competence were evaluated by Transesophageal echocardiography (TEE) and continuing increase balloon size. Results:Echocardiographic follow-up assessment was performed in 54 patients serially in a interval of 3 months or 6 months. Their mean age was 46±11 years (24 to 66 years) and the mean total echocardiographic score was 7.1±1.6. A optimal result was obtained in 95% of the cases (51/54). The post-PMV mitral valve area increased to 1.95±0.37 cm and 1.79± 0.28 cm by 2-D and Doppler method, the average transmitral mean diastolic pressure gradient decreased to 5.16±2.8 mmHg and LA pressure was decreased to 11.28±8.2 mmHg. The newly developed and aggravated mitral regurgitation was observed in 17 patients (31.5%). The restenosis was noted in 2 cases (3.7%) after 1 year follow-up. The pre-procedural echocardiographic score for leaflet mobility, thickening and calcification was more higher in patients with restenosis. There was significant tendency of decrement in the mitral valve area in patients with a echocardiographic score>8 compared with those≤8 over 6 months after the PMV. Conclusion: PMV with the Inoue balloon under TEE guide as a combined treatment modality of patient with symptomatic mitral stenosis is relatively safe and achieves good immediate and midterm follow-up results. The echocardiographic score is considered as useful predictor of midterm results and restenosis after PMV with Inoue balloon. (Korean Circulation J 1998;28(11):1841-1851)