Influence of commissural calcification on the immediate outcomes of percutaneous balloon mitral valvuloplasty

Abstract

Objectives — To evaluate the impact of mild to moderate commissural calcification on the immediate outcomes of percutaneous balloon mitral valvuloplasty (PBMV).Methods and results — We analysed the results of 223 consecutive patients (mean age 37.6±8.7 years) who underwent PBMV for rheumatic mitral stenosis. Commissural calcification was identified with a two-dimensional echocardiography (echo) in 65 (29.1%) patients with the severity of calcification being graded from 0-3.The anatomy and function of the mitral valve were assessed by Wilkins echo score. In patients with no commissural calcification the increase in mitral valve area after PBMV was 0.90±0.42 cm2, which was greater than the increase in those with calcification grade 1 (0.83± 0.42 cm2, p<0.05), grade 2 (0.72±0.38 cm2, p<0.05) and grade 3 (0.63±0.13 cm2, p<0.05). In patients with an echo score of ≤8, the presence of commissural calcification was associated with a smaller increase in mitral valve area (p<0.05) and a smaller reduction in New York Heart Association (NYHA) function class after PBMV (p<0.05). In patients with an echo score of more than 8, commissural calcification had no significant effect on the valve area increase and NYHA function class reduction (p>0.05).Conclusions — Commissural calcification has an adverse effect on the clinical results of PBMV. Detailed pre-procedural assessment of commissural calcification with echocardiography must be performed to provide background information on the immediate outcomes of PBMV.