Effect Of Balloon Mitral Valvuloplasty Research Articles

Immediate, short-term, and long-term effects of balloon mitral valvuloplasty on the left atrial global longitudinal strain and its correlation to the outcomes in patients with severe rheumatic mitral stenosis

BackgroundLeft atrial global longitudinal strain (LA GLS) has been used as a new assessment tool for left atrial function. This article aims to investigate the effect of balloon mitral valvuloplasty (BMV) in patients with severe rheumatic mitral stenosis on LA GLS and its relation to the mitral valve area achieved after the procedure. The study included 95 patients with severe mitral stenosis who fulfilled the criteria for BMV (case group) and 80 normal healthy subjects (control group). All included participants underwent complete echocardiographic examinations. For the case group, LA GLS was assessed by 2D speckle-tracking Echocardiography before valvuloplasty, immediately after, within 24 h, at 6 months, and at 12 months, and the results were compared.ResultsThe impaired left-atrium strain in patients with severe mitral stenosis was improved immediately after BMV, and the improvement continued at 6 and 12 months post-BMV (23.1% ± 4.2 vs. 36.0% ± 4.9, 36.2% ± 4.5, and 40.1% ± 9.5, respectively p < 0.01). After BMV, there was a significant decrease in left atrial volume (76.3 ± 12.4 ml/m2 vs. 68.6 ± 10.4 ml/m2, p < 0.01) and a significant increase in the area occupied by the mitral valve (1.02 ± 0.18 cm2 vs. 1.60 ± 0.31 cm, p < 0.01). The immediate LA GLS and the mitral valve area were positively correlated (r = 0.64, p < 0.01). Furthermore, the immediate LA GLS was associated with significantly improved function class (p < 0.01).ConclusionsLA GLS can indicate left atrial (mainly reservoir) function. The improvement observed in patients after BMV may indicate that LA GLS can be used to evaluate the progress after BMV.Trial registration: The study was approved by the local ethics committee of the Faculty of Medicine in Minia University (Registration No. MUFMIRB 324-4-2022). Institutional Review Board, Faculty of Medicine, Minia University, Egypt. 324-4-2022, 24 18 April, 2022.

Immediate, short-term, and long-term effects of balloon mitral valvuloplasty on the left atrial global longitudinal strain and its correlation to the outcomes in patients with severe rheumatic mitral stenosis

Abstract Background Global longitudinal left atrial strain (GLS) has been used as a new assessment tool for left atrial function. Aim To investigate the effect of balloon mitral valvuloplasty (BMV) in patients with severe rheumatic mitral stenosis on GLS and its relation to the mitral valve area achieved after the procedure. Methods The study included 95 patients with severe mitral stenosis who fulfilled the criteria for BMV (case group) and 80 normal healthy subjects (control group). All included participants underwent complete echocardiographic examinations. For the case group, GLS was assessed by 2D speckle-tracking Echocardiography before valvuloplasty, immediately after, within 24 h, at 6 months, and at 12 months, and the results were compared. Results The impaired left-atrium strain in patients with severe mitral stenosis was improved immediately after BMV, and the improvement continued at 6 and 12 months post-BMV (23.1% ± 4.2 vs. 36.0 % ± 4.9, 36.2% ± 4.5, and 40.1% ± 9.5, respectively P &amp;lt; 0.01). After BMV, there was a significant decrease in left atrial volume (76.3 ± 12.4 mL/m2 vs. 68.6 ± 10.4 mL/m2, P &amp;lt; 0.01) and a significant increase in the area occupied by the mitral valve (1.02 ± 0.18 cm2 vs. 1.60 ± 0.31 cm, P &amp;lt; 0.01).The immediate GLS and the mitral valve area were positively correlated (r = 0.64, P &amp;lt; 0.01). Furthermore, the immediate GLS was associated with significantly improved function class (P &amp;lt; 0.01). Conclusion GLS can indicate left atrial function (mainly reservoir function). The improvement observed in patients after BMV may indicate that GLS can be used to evaluate the progress after BMV. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Effect of balloon mitral valvuloplasty on mitral valve resistance and its correlation with clinical outcome

Effect of balloon mitral valvuloplasty on mitral valve resistance and its correlation with clinical outcome

Acute and short term effect of balloon mitral valvuloplasty on p wave dispersion and atrial electro-mechanical delay in subjects of mitral stenosis

Acute and short term effect of balloon mitral valvuloplasty on p wave dispersion and atrial electro-mechanical delay in subjects of mitral stenosis

Immediate and short-term effect of balloon mitral valvuloplasty on global and regional biventricular function: a two-dimensional strain echocardiographic study.

To assess the effect of balloon mitral valvuloplasty (BMV) on global and regional ventricular functions using 2D strain. Thirty-two patients with mitral stenosis (MS) and 30 healthy subjects underwent full echocardiographic examinations, including left ventricle (LV) and right ventricle (RV) regional and global longitudinal strain (GLS) measurements. In MS patients, measurements were repeated within 24 h and 3 months after BMV. Patients with MS had lower LV and RV GLS compared with control group (-16.5 ± 2.7% vs. -21.0 ± 1.5) and (-18.3 ± 4.7 vs. -19.8 ± 1.3), respectively. Significant decrease was noted in the basal and septal segments compared with the apical LV segments and RV free wall. BMV resulted in significant improvement in LV and RV GLS within 24 h post-BMV compared with baseline values (P = 0.0001 and 0.0002, respectively), an improvement which was maintained after 3 months. There was significant positive correlation between both LV and RV GLS at baseline and mitral valve mean pressure gradient and RV systolic pressure and significant inverse correlation between LV GLS and MVA. MS patients have subclinical LV and RV systolic dysfunction by GLS despite normal ejection fraction and fractional area change. BMV results in marked improvement in LV and RV GLS immediately post-BMV with trend towards normalization at follow-up after 3 months. A mixed aetiology theory involving a myocardial as well as a haemodynamic factor is believed to be the cause for this subclinical biventricular dysfunction and its improvement at short-term follow-up post-BMV.

Worsening of left ventricular twist mechanics in isolated rheumatic mitral stenosis immediately after balloon mitral valvuloplasty

Abstract Background Reportedly, left ventricular (LV) mechanics are worsened in patients with mitral stenosis (MS) compared to controls. The immediate effect of balloon mitral valvuloplasty (BMV) on LV mechanics is, however, not known. Aim To assess the immediate effect of balloon mitral valvuloplasty on the left ventricular twist mechanics. Methods and results We studied 39 candidates for BMV. Pressures were measured invasively before and after BMV. Speckle tracking echocardiography (STE) was done for twist mechanics (basal rotation, apical rotation, and torsion) before and immediately after BMV. Twist mechanics were also measured by STE in 15 normal subjects as control group. Mean age was 30.4 ± 7.2 years, mean BMI was 24.7 ± 3.1 and 28 patients (72%) were females. All twist mechanics apical rotation and torsion were lower post-BMV compared to pre-BMV. Left ventricular end diastolic pressure was significantly higher post compared to pre-BMV while left atrial pressure (LAP) was similar between both groups. Importantly, patients who showed an increased LVEDP post compared to pre-BMV had worse LV twist mechanics than those whose LVEDP post-BMV was similar to or lower than pre-BMV. Conclusion LV twist mechanics are worsened in MS with a further worsening, immediately after BMV probably because of failure of the LV to adapt to the sudden increased preload.

140: Left atrial remodeling after successful ballon mitral valvuloplasty

Left atrium (LA) remodeling has a crucial adverse impact on outcome and prognosis in mitral stenosis. Few studies have reported the effect of balloon mitral valvuloplasty (BMV) on LA volume and function. The aim of this study was to assess the evolution of LA volume and compliance 1 and 6 months after successful BMV in patients in sinus rhythm. 95 consecutive patients (70% women; age 31±8 years; range 19-45) with severe mitral stenosis (mitral valve area ≤14 cm(2)) who underwent successful BMV were included prospectively. Using-dimensional echocardiography, and according to the prolate ellipse method, LA volume, area and compliance (The maximum and the minimum LA volume were calculated from apical four- and two-chamber zoomed views of the LA, using the biplane method of discs. The difference between maximum and minimum LA volume divided by the minimum LA volume was used as an index of atrial compliance) were determined before BMV, and 1 month and 6 months after BMV. LV global systolic function was evaluated by EF, by the biplane Simpson method. Longitudinal left ventricular annular velocities were quantified by spectral pulsed wave Doppler tissue velocity imaging Mitral valve area increased from 0.88±0.2 to 1.8±0.26 cm(2) (P<0.0001). Mean mitral valve gradient (MVG) decreased from 14±6 to 6±2 mmHg (P<0.0001) immediately after BMV. Indexed LA volume fell from 66±14 to 52±12 mL/m (2) (P=0.02) after BMV and to 45±13 mL/m (2) at 6 month (P<0.01) and an increase 0f the atrial index. Only patients with a median LA volume ≥55 mL/m (2) before BMV had a significant reduction in LA volume (P=0.0001). Decrease in LA volume was correlated with decreases in PA-RV peak diastolic gradient (r=0.45, P=0.008) and MVG (r=0.35, P=0.04). In patients with mitral stenosis in sinus rhythm, successful BMV results in an immediate decrease in LA volume. This reduction, maximal immediately after BMV, correlates with decreases in MVG and PA-RV peak diastolic gradient, and is significant only when LA volume before BMV is severely enlarged.

149 Decrease in left atrium volume after successful balloon mitral valvuloplasty: an echographic and hemodynamic study

L eft atrium (LA) remodeling has a crucial adverse impact on outcome and prognosis in mitral stenosis (MS). Few studies have reported the effect of balloon mitral valvuloplasty (BMV) on LA volume. The aim of this study was to assess the evolution of LA volume immediately and 1 month after successful BMV in patients in sinus rhythm . Thirty-three consecutive patients (70% women; age 31 ± 8 years; range 19–45) with moderate to severe MS (mitral valve area 1.5 cm 2 ) who underwent successful BMV were included prospectively. Using two-dimensional echocardiography, and according to the prolate ellipse method, LA volume and LA volume indexed to body surface area were determined before BMV, 24 hours and 1 month after BMV. Pulmonary artery–right ventricular (PA-RV) gradients, reflecting pulmonary pressures, and pulmonary vascular resistance were measured. Mitral valve area increased from 0.88 ± 0.16 to 1.55 ± 0.26 cm 2 (p < 0.0001). Mean mitral valve gradient (MVG) decreased from 16 ± 6 to 6 ± 2 mmHg (p < 0.0001) immediately after BMV. Indexed LA volume fell from 56 ± 14 to 48 ± 12 mL/m 2 (p = 0.0002) immediately after BMV and to 45 ± 13 mL/m 2 at 1 month (p < 0.0001). Only patients with a median LA volume 55 mL/m 2 before BMV had a significant reduction in LA volume (p = 0.0001). Decrease in LA volume was correlated with decreases in PA–RV peak diastolic gradient (r = 0.45, p = 0.008) and MVG (r = 0.35, p = 0.04). In patients with MS in sinus rhythm, successful BMV results in an immediate decrease in LA volume. This reduction, maximal immediately after BMV, correlates with decreases in MVG and PA–RV peak diastolic gradient, and is significant only when LA volume before BMV is severely enlarged. Change in indexed LA volume after BMV Left atrium variables Before BMV After BMV 1 month after BMV p value (before vs after) p value (before vs at 1 month Volume, mL 77 ± 22 66 ± 18 62 ± 18 0.0003 <0.0001 Indexed volume, mL/m 2 56 ± 14 48 ± 12 45 ± 13 0.0002 <0.0001 Anteroposterior diameter, mm 44 ± 5 41 ± 5 40 ± 6 <0.0001 <0.0001 Inferosuperior diameter, mm 67 ± 6 66 ± 6 65 ± 6 0.5 0.07 Mediolateral diameter, mm 48 ± 6 45 ± 5 45 ± 4 0.02 0.007 Area, cm 2 27 ± 5 25 ± 4 25 ± 4 0.02 0.003

Decrease in Left Atrium Volume after Successful Balloon Mitral Valvuloplasty: An Echocardiographic and Hemodynamic Study

Left atrium (LA) remodeling has a crucial adverse impact on outcome and prognosis in mitral stenosis. Few studies have reported the effect of balloon mitral valvuloplasty (BMV) on LA volume. The aim of this study was to assess the evolution of LA volume immediately and 1 month after successful BMV in patients in sinus rhythm. Thirty-three consecutive patients (70% women; age 31 ± 8 years; range 19-45) with moderate to severe mitral stenosis (mitral valve area ≤1.5 cm(2) ) who underwent successful BMV were included prospectively. Using two-dimensional echocardiography, and according to the prolate ellipse method, LA volume and LA volume indexed to body surface area were determined before BMV, and 24 hours and 1 month after BMV. Tricuspid and pulmonary regurgitation jets were recorded systematically using continuous-wave Doppler. Pulmonary artery-right ventricular (PA-RV) gradients, reflecting pulmonary pressures, and pulmonary vascular resistance were measured. Mitral valve area increased from 0.88 ± 0.16 to 1.55 ± 0.26 cm(2) (P < 0.0001). Mean mitral valve gradient (MVG) decreased from 16 ± 6 to 6 ± 2 mmHg (P < 0.0001) immediately after BMV. Indexed LA volume fell from 56 ± 14 to 48 ± 12 mL/m(2) (P = 0.0002) immediately after BMV and to 45 ± 13 mL/m(2) at 1 month (P < 0.0001). Only patients with a median LA volume ≥55 mL/m(2) before BMV had a significant reduction in LA volume (P = 0.0001). Decrease in LA volume was correlated with decreases in PA-RV peak diastolic gradient (r = 0.45, P = 0.008) and MVG (r = 0.35, P = 0.04). In patients with mitral stenosis in sinus rhythm, successful BMV results in an immediate decrease in LA volume. This reduction, maximal immediately after BMV, correlates with decreases in MVG and PA-RV peak diastolic gradient, and is significant only when LA volume before BMV is severely enlarged.

Use of Real-time 3-dimensional Transthoracic Echocardiography in the Evaluation of Mitral Valve Disease

Three-dimensional (3D) echocardiography (3DE) provides unique orientations of the mitral valve (MV) not obtainable by routine 2-dimensional echocardiography. However, this modality has not been adopted in routine clinical practice because of its cumbersome and time-consuming process. The recent introduction of a full matrix-array transducer has enabled online real-time 3DE (RT3DE) and rendering. This study was designed to: (1) determine the clinical use of RT3DE in patients with MV pathology and in a control group selected for their good acoustic windows (protocol I); and (2) to investigate the feasibility of imaging the MV apparatus in a large group of consecutively imaged patients to determine the acoustic window or perspective from which the MV leaflets, commissures, and orifice are best visualized (protocol II). In protocol I, 65 patients were selected based on MV pathology and good 2-dimensional echocardiography image quality. Protocol II included 150 patients who were consecutively imaged using RT3DE. Images were viewed online (protocol I) and offline on a digital review station (protocol II). RT3DE visualization of the MV apparatus was graded based on the percentage of leaflet dropout and definition. In protocol I, 78% of patients had adequate 3D MV reconstructions with complete visualization of the anterior mitral leaflet (AML) in 84% versus the posterior mitral leaflet (PML) in 77%. The mitral leaflets, commissures, and MV orifice were well seen in 98%; however, the submitral apparatus was only observed in 76% of the patients. RT3DE: (1) correctly identified the prolapsed/flailed scallop in 6 of 8 patients; (2) obtained en face orientation of the MV orifice in 9 of 11 patients with mitral stenosis, allowing accurate measurements of the orifice area and evaluation of the immediate effects of balloon mitral valvuloplasty; and (3) allowed postoperative evaluation of MV repair and the integrity of the struts of a bioprosthetic leaflet. In protocol II, 70% of patients had adequate RT3DE with complete visualization of the AML noted in 55% versus 51% for PML. The mitral leaflets, commissures, and MV orifice were observed in 69%. Irrespective of acquisition window, the AML was best seen from a ventricular perspective. In contrast, the PML was optimally examined from a parasternal window. Both the medial and lateral commissures were equally assessed from either imaging window. In conclusion, RT3DE of the MV is feasible in a large majority of patients. Using different MV acquisitions RT3DE provides important clinical information such as: (1) identification of a prolapsed/flail scallop; (2) measurement of stenotic valve areas; (3) evaluation of MV leaflet integrity postrepair; and (4) identification of a MV perforation. In general the AML is better visualized than the PML. The parasternal window is the optimal approach to visualize both AML and PMLs.

Favorable effect of balloon mitral valvuloplasty on the incidence of atrial fibrillation in patients with severe mitral stenosis

The long-term effect of balloon mitral valvuloplasty (BMV) on the incidence of atrial fibrillation (AF) in patients with severe mitral stenosis (MS) remains undetermined. To assess the effect of successful BMV on the incidence of chronic AF in patients with severe MS, compare the results with historical controls, and identify factors associated with AF in such patients. Retrospective analysis of 382 consecutive patients with severe MS and in sinus rhythm (SR) who underwent successful BMV (post procedure mitral valve area (MVA) > or =1.5 cm(2), mitral regurgitation (MR) < or =2/4) at our hospital and followed-up for 1-15.6 (mean 5.6 +/- 3.9) years with clinical and echocardiographic examination. Thirty-four (8.9%) patients developed AF at follow-up (group A) and 348 patients (group B) remained in SR. At baseline, and in comparison with group B, patients who developed AF (group A) were older, had higher mitral echo score but equal MVA and left atrial (LA) size. The postprocedure MVA was smaller in group A (1.7 +/- 0.3 cm(2)) than in group B (2.0 +/- 0.2 cm(2;) P = 0.002). At follow-up, and in comparison to group B, group A had smaller MVA (1.5 +/- 0.4 cm(2) vs 1.8 +/- 0.4 cm(2) P <0.0001), larger LA dimension (49.4 +/- 6.5 vs 42 +/- 6.5 mm; P <0.0001) and higher restenosis rate (35% vs 14%; P = 0.001). Multivariate logistic regression analysis identified age at follow-up (P < 0.0001), LA size at follow-up (P = 0.004), and MVA at follow-up (P = 0.006) as predictors of AF. This study demonstrated favorable effect of BMV on the incidence of AF (8.9%) in patients with severe MS in comparison with reported series (29%) of patients with severe MS with similar baseline characteristics who were not submitted to any intervention. The predictors of AF were age, larger LA, and smaller MVA, at follow-up.

Response of different grades of pulmonary artery hypertension to balloon mitral valvuloplasty

Pulmonary artery hypertension (PAH) in rheumatic mitral stenosis adversely affects long-term prognosis.1,2 Balloon mitral valvuloplasty (BMV) exerts favorable effects on PAH in mitral stenosis.3–5 Results of BMV are comparable to those after surgery.6 Patients with severe PAH show immediate benefit after BMV.7,8 However, it is not known how different grades of PAH behave after BMV. There are no large studies on the effects of BMV on various grades of PAH. The present study on patients with different degrees of PAH (1) analyzes the immediate outcome and follow-up of residual PAH after BMV, (2) predicts the factors that determine the immediate decrease in PAH, and (3) throws light on the severity of the disease process in patients with greater degrees of PAH.

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis: authors’ reply

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis: authors’ reply

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis: authors’ reply

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis: authors’ reply

Effect of balloon mitral valvuloplasty on left atrial appendage function and spontaneous echo contrast in patients with severe mitral stenosis: A transesophageal echocardiographic follow-up study Kewal C. Goswami, M. Bhaskararao, Rakesh Yadav, Kewal K. Talwar, Vinay K. Bahl and Subbash C. Manchanda. Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India

Effect of balloon mitral valvuloplasty on left atrial appendage function and spontaneous echo contrast in patients with severe mitral stenosis: A transesophageal echocardiographic follow-up study Kewal C. Goswami, M. Bhaskararao, Rakesh Yadav, Kewal K. Talwar, Vinay K. Bahl and Subbash C. Manchanda. Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis

A proportion of mitral stenosis patients with left atrial spontaneous echo contrast but without thrombus exhibit a regional hypercoagulable state, characterized by increased left atrial levels, but normal venous levels, of prothrombin fragment 1+2 (F1+2), a marker of thrombin generation. Valve dilatation by balloon mitral valvuloplasty has beneficial effects on left atrial spontaneous echo contrast, but its effect on left atrial thrombin generation is unknown. We examined the effects of balloon mitral valvuloplasty on venous and left atrial levels of F1+2 in 37 patients with mitral stenosis, divided into those with normal (group 1; n=22) and those with increased (group 2; n=15) regional left atrial thrombin generation, as described previously. The mitral valve area increased by a similar degree after the valvuloplasty procedure in the two groups. In group 1, the venous (P<0.005) and left atrial (P<0.0005) levels of F1+2 increased similarly after valvuloplasty, and as a result the left-atrial-venous F1+2 difference was unchanged. The venous F1+2 level also increased after valvuloplasty in group 2 (P<0.005); however, in contrast with group 1, the left atrial level decreased (P<0.03) and as a result the left-atrial-venous difference fell (P<0.05). These results show that balloon mitral valvuloplasty results in an immediate increase in thrombin generation, but a decrease in the left-atrial-venous F1+2 difference, in patients with increased left atrial thrombin generation. The divergent changes in venous and left atrial levels of F1+2 further highlight the limitations of assessing regional changes in coagulation activity by measuring venous levels of coagulation markers.

Immediate effect of balloon valvuloplasty on hemostatic changes in mitral stenosis

This study was conducted to assess right and left atrial hemostatic function in patients with mitral stenosis (MS) and to investigate the immediate effect of balloon mitral valvuloplasty (BMV) on hemostatic function. BMV was performed in 28 patients with MS (age 29 ± 8 years) who had sinus rhythm and no left atrial (LA) thrombus. Right and left atrial biochemical markers of platelet activity (platelet factor 4 [PF4] and B thromboglobulin [BTG]), coagulation (thrombin-antithrombin III complex [TAT]), and fibrinolytic activity ( D-dimer) were measured before and 30 minutes after BMV. Right atrial levels of these markers were also measured in 20 control subjects. Compared with control subjects, patients with MS had higher right atrial levels of PF4 (30 ± 15 vs 5 ± 2 IU/ml), BTG (231 ± 53 vs 30 ± 8 IU/ml), TAT (7 ± 4 vs 2 ± 0.3 μg/L), and D-dimer (380 ± 145 vs 160 ± 35 ng/ml, p <0.0001 in all). TAT levels were higher in the left atrium than in the right atrium of patients before BMV (8 ± 4 vs 7 ± 4 μg/L, p <0.0001). BMV was successful (final mitral valve area ≥1.5 cm 2 and ≥50% increase of the initial valve area) in all patients. There was a significant reduction of LA levels of PF4 (35 ± 8 to 26 ± 9 IU/ml, p <0.0001), BTG (225 ± 41 to 196 ± 28 IU/ml, p <0.001), and TAT (10 ± 5 to 7 ± 1 μg/L, p <0.05) in the 16 patients with LA pressure <10 mm Hg after BMV, whereas these markers were not reduced in the 12 patients with left atrial pressure ≥10 mm Hg after BMV. These data indicate that platelet function, coagulation status, and fibrinolytic activity are increased regionally in the left atrium and in the systemic circulation in patients with MS and sinus rhythm in the absence of LA thrombus. Successful BMV induces a significant reduction of prethrombotic status in patients with low LA pressure after the procedure. Patients with high LA pressure after BMV maintain a high prethrombotic state and may be considered at an increased risk of thromboembolism after the procedure.