Percutaneous balloon mitral valvuloplasty for mitral stenosis with and without associated aortic regurgitation

Abstract

Between November 1985 and December 1991, percutaneous balloon mitral valvuloplasty (PBMV) with the inoue balloon catheter (Toray Marketing & Sales [America], Inc., New York, N.Y.) was performed in 53 patients with rheumatic mitral stenosis and associated mild to moderate aortic regurgitation. Mean left atrial pressure was 22.5 ± 8.6 mm Hg and 9.7 ± 5.5 mm Hg before and after PBMV, respectively ( p < 0.001). The mean diastolic mitral gradient as determined by the catheter method decreased from 18.7 ± 11.4 mm Hg to 2.1 ± 3.1 mm Hg ( p < 0.001). The echocardiographic mitral valve area was 1.0 ± 0.2 cm 2, 2.0 ± 0.6 cm 2, and 1.9 ± 0.5 cm 2, before and after PBMV and at follow-up ( p < 0.001 before PBMV vs after PBMV and at follow-up). The mean diastolic mitral gradient as determined by two-dimensional and Doppler echocardiography was 19.3 ± 8.4 mm Hg, 5.2 ± 4.1 mm Hg, and 6.6 ± 3.3 mm Hg, before and after PBMV and at follow-up, respectively ( p < 0.001). The phonocardiographic interval between the Q wave and the mitral component of the first heart sound was 85.2 ± 15.2 msec, 74.2 ± 13.4 msec, and 72.3 ± 15.7 msec before and after PBMV and at follow-up ( p < 0.001 before PBMV vs after PBMV and at follow-up). The phonocardiographic interval between the aortic second sound and opening snap was 73.4 ± 18.1 msec, 88.7 ± 9.6 msec, and 92.1 ± 11.7 msec before and after PBMV and at follow-up ( p < 0.001 before PBMV vs after PBMV and at folow-up). The voltage of P loop in the frontal plane of the vectorcardiogram was 0.25 ± 0.04 mV, 0.21 ± 0.04 mV, and 0.20 ± 0.03 mV before and after PBMV and at follow-up ( p < 0.001 before PBMV vs after PBMV and at follow-up). The New York Heart Association classification improved from class II in 26 patients and class III in 27 patients before PBMV to class I in 48 patients and class II in five patients after PBMV. These hemodynamic, noninvasive, and clinical results were not significantly differnt from those that were obtained in 112 patients with mitral stenosis without associated aortic regurgitation, who were studied during the same period in our cardiac catheterization laboratory. It was concluded that patients with rheumatic mitral stenosis are suitable candidates for PBMV whether or not they have associated aortic regurgitation of mild to moderate degree.