Balloon Mitral Valvuloplasty Research Articles

Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.

PurposeAssociations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy.MethodsMedline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529).FindingsThe search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54–5.33), and perinatal death (6 studies, RR 3.23, 1.92–5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02–4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02–5.95).InterpretationRHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.

Short- and mid-term outcomes of percutaneous balloon mitral valvuloplasty under the guidance of ultrasound

Objective: To evaluate the safety, short- and mid-term outcomes of percutaneous balloon mitral valvuloplasty (PBMV) guided by the ultrasound. Methods: In this retrospective study, medical data of 15 patients [9 males and 6 females, with an age of (53±13) years] with PBMV under the guidance of ultrasound in Heart Center of Henan Provincial People's Hospital between December 2016 and January 2019 were collected and reviewed. The short-and mid-term outcomes were analyzed. Results: PBMV was successfully performed in all the patients. One patient underwent surgical valve replacement due to severe mitral regurgitation, and the other 14 patients were all followed up successfully. The average follow-up time was (13.8±4.6) months. Comparisons of preoperative and postoperative data showed significant differences in valve area [(1.84±0.43) cm2 vs (0.89±0.24) cm2], left atrial pressure [(11.9±4.5) mmHg (1 mmHg=0.133 kPa) vs (21.9±6.0) mmHg] and mean mitral valve pressure gradient [(10.9±3.2) mmHg vs (20.1±3.6) mmHg](all P<0.01), with no significant differences in mitral regurgitation area (P=0.67). Postoperative follow-up showed that there were no significant differences in mitral valve area, regurgitation area and N-terminal pro-B-type natriuretic peptide (NT-proBNP) between short-and mid-term postoperatively (all P>0.05). There was no secondary operation due to mitral stenosis in 14 patients, and 3 patients with moderate or severe tricuspid regurgitation showed significant improvement, with gradually recovered cardiac function, and there were no deaths in these patients. Conclusion: PBMV guided by the ultrasound is feasible and effective, and exhibits favorable short-and mid-term outcomes.

Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study.

Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied.Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function.Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated.Results: At baseline, patients had median EF of 57 (range: 45–69) %, LVEDVI of 74 (44–111) ml/m2 and LVESVI of 31 (14–57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (−16.4 vs. −13.8, p < 0.001) and global circumferential strain (GCS) (−17.8 vs. −15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (−17.9 vs. −16.4, p = 0.008) and GCS (−19.4 vs. −17.8 p = 0.03).Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.

Unusual Mechanism and Unusual Combination of Two Common Diseases

Balloon mitral valvuloplasty (BMV) is an accepted treatment for certain subsets of patients of mitral stenosis. Prior to BMV, a full clinical and echocardiographic evaluation is done. This 36-years old lady of severe mitral stenosis had two BMV's including a three-dimensional transesophageal echocardiography at leading cardiac centers. However, an important echocardiographic finding was missed which would have altered the course of management. These details are discussed.

Outcome of Rheumatic Heart Disease and Percutaneous Balloon Mitral Valvotomy

Abstract Background: Rheumatic heart disease (RHD) is still a leading cause of valvular heart disease in India. Balloon mitral valvotomy (BMV) is simple and safe procedure to improve the quality of life in patients with severe mitral stenosis. Aim: (1) To evaluate outcome of RHD patients in tertiary care hospital in developing country like India in twenty first century. (2) To evaluate safety and efficacy of BMV. Materials and Methods: We performed retrospective analysis of 500 patients with RHD undergoing echocardiography in a tertiary care hospital in Maharashtra, India. 15% (74 patients) of them underwent balloon mitral valvuloplasty between June 2012 and November 2019 and 37.6% (188 patients) were treated with valve replacements. Results: Successful BMV was performed in 72 patients. The rate of complication was 2.7%. No mortality was noted. One hundred and eighty-eight patients underwent Valve replacements. Conclusions: Balloon mitral valvuloplasty is a technically difficult procedure and demands considerable expertise in transseptal catheterization. Percutaneous balloon mitral valvotomy is a safe and effective treatment for symptomatic severe Mitral stenosis in experienced centers.

Clinical and echocardiographic trends in percutaneous balloon mitral valvuloplasty

BackgroundThe prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years.MethodsWe conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019.ResultsFour hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001).ConclusionOur research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

A new over-the-wire percutaneous mitral balloon valvuloplasty technique.

To develop and evaluate a new over-the-wire technique for mitral valvuloplasty that is both technically easier and less costly. Rheumatic heart disease (RHD) and resultant mitral stenosis (MS) carries a significant burden of disease worldwide. The prevalence is however concentrated in lower income countries where the current gold standard for percutaneous mitral valvuloplasty (PMBV)-the Inoue technique, is not always available due to cost and technical complexity. The development of an over-the-wire technique involving a steerable catheter to aid crossing of the valve and a dedicated TAVI wire is described. The procedure evolved over the initial eight cases and the final standardized procedure was performed in 16 cases. Clinical, echocardiographic and procedural outcomes are described in 16 consecutive cases performed at a single center. The procedure was performed with 88% procedural success and only one technical failure during the development phase. 2/24 patients had moderate mitral regurgitation (MR) afterwards but one had unfavorable anatomy and the other had pre-procedural moderate MR. The average procedural duration was 66 min, which was shortened significantly over time. No procedural deaths or conversion to open surgery at 1 year. Procedural cost was 44% lower than the Inoue technique. We present favorable results of a new PMBV technique that is cheaper and technically easier in our opinion.

Outcomes of Percutaneous Balloon Mitral Valvuloplasty in Significant Mitral Stenosis with Moderate Mitral Regurgitation - Single Center Study

Outcomes of Percutaneous Balloon Mitral Valvuloplasty in Significant Mitral Stenosis with Moderate Mitral Regurgitation - Single Center Study

Validation of New Real-Time Three-Dimensional Transesophageal Echocardiographic Scoring System in Prediction of Immediate and Long-term Outcome After Percutaneous Balloon Mitral Valvuloplasty

Dear Editor,The guidelines recommend percutaneous mitral balloon commissurotomy (PMBC) as the first choice therapy for symptomatic patients with moderate or severe mitral stenosis (MS) with favorable valve morphology and for asymptomatic MS patients with pulmonary hypertension (1). Echocardiography is the main diagnostic imaging method for assessing mitral valve stenosis and evaluating the severity and hemodynamic consequences of MS as well as valve morphology and disease extension (2). The main predictor of successful BMV is mitral valve morphology. Therefore, the MV scoring system using echocardiography is very important. Several two-dimensional echocardiographic scoring systems have been proposed to evaluate MV morphology, the severity of which is related to immediate and long-term outcome (3). Most cardiologists use the Wilkins score for evaluation of MV anatomy. Although, none of the available 2DE scores have not been shown to be superior to any of the other scores (4). The evaluation of the MV Wilkins score depends on the assessment of four parameters, which include: leaflets mobility, thickness, calcification, and subvalvular involvement. Each parameter is given a score of 1-4 and by calculating its sum, the total score of 1-16/16 (mild involvement = 1-4/16, moderate involvement = 5-8/16, and severe involvement &gt; 8/16) is obtained (3). The ideal echocardiographic scoring system should have the following characteristics:Quantitative and qualitative evaluation of each component of the MV apparatus separately to determine the deformity in a specific portionThe inclusion of all the points that have been proven through a large study affects the BMV resultEasy to use and interpretable by most cardiologists at a reasonable timeHigh reliability and reproducibility (4)In recent years, real-time three-dimensional echocardiography technology has evolved rapidly. RT3DE provides detailed morphologic display and analysis of the mitral valve structure. Improving the RT3DE probe technology, especially transesophageal probes, highlights the need to introduce a RT3DE scoring system (5). Anwar et al. introduced the first scoring system using real-time three-dimensional transthoracic echocardiography (RT3D-TTE) in patients with mitral valve stenosis candidate BMV, and compared the new score with the Wilkins score in predicting outcome after BMV. In the new RT3DE score, each leaflet was divided into three scallops (anterolateral A1-P1, middle A2-P2, and posteromedial A3-P3) and each scallop was scored separately for thickness, calcification, and mobility, as follows: 0 for normal thickness and mobility, 1 for abnormal thickness and restricted mobility, and for scoring calcification: 0 for the absence of calcification, 1 for calcification of middle scallop (A2 or P2) and 2 if there is calcification of commissural scallops (A1, A3-P1, P3). For scoring subvalvular apparatus, the anterior and posterior chordae were scored at three levels as follows: proximal (valve level), middle, and distal (papillary muscle level). Each level was scored separately for thickness and separation in between as follows: 0 for normal thickness, 1 for abnormal thickness, also 0 in case of normal chordal separation (distance in between &gt;5 mm), 1 in case of partial separation (distance in between &lt;5 mm) and 2 in case of absence separation. From the sum of these points, a total score of 0-31/31 (mild MV involvement &lt;8, moderate MV involvement 8-13, and severe MV involvement &gt;14) is obtained (6). 3D-Anwar score is complex and time consuming. This is due to the many anatomical and morphological components to achieve an accurate assessment. The available 3D score is highly selective for optimal BMV result, which leads to more patients being referred for surgery (5). So we decided to introduce a three-dimensional transesophageal (3D-TEE) echocardiographic scoring system that meets the criteria of an ideal echocardiographic scoring system, and evaluate the validity of the new score in predicting the immediate and long-term outcome of patients after BMV. We also believe that many studies are needed to achieve an ideal RT3DE scoring system.

Comparison of early and long-term follow-up results of percutaneous mitral balloon valvuloplasty and mitral valve replacement.

Percutaneous mitral balloon valvuloplasty and mitral valve replacement have been the treatment options for mitral stenosis for several years, however, studies that compare these two modalities are very rare in the literature. In this article, we aim to investigate the comparison of clinical results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. 527 patients with rheumatic mitral stenosis, treated with percutaneous mitral balloon valvuloplasty or mitral valve replacement (276 patients with percutaneous mitral balloon valvuloplasty and 251 patients with mitral valve replacement) from 1991 to 2012 were evaluated. The demographic characteristics, clinical, echocardiographic and catheterization data of patients were evaluated retrospectively. The results of early and late clinical follow-up of patients after percutaneous mitral balloon valvuloplasty and mitral valve replacement were also evaluated. The mean follow-up time of the percutaneous mitral balloon valvuloplasty group was 4.7 years and, for the mitral valve replacement-group, it was 5.45 years. The hospital stay of the percutaneous mitral balloon valvuloplasty group was shorter than that of the mitral valve replacement group (2.02 days vs 10.62 days, p<0.001). The hospital mortality rate of percutaneous mitral balloon valvuloplasty and mitral valve replacement were 0% and 2% respectively (p=0.024). In the percutaneous mitral balloon valvuloplasty group, early postprocedural success rate was 92.1%. The event-free survival of percutaneous mitral balloon valvuloplasty and mitral valve replacement was found to be similar. While reintervention was higher in percutaneous mitral balloon valvuloplasty-group (p<0.001), mortality rate was higher in mitral valve replacement-group (p<0.001). Percutaneous mitral balloon valvuloplasty seems to be more advantageous than mitral valve replacement due to low mortality rates, easy application of the procedure and no need for general anesthesia.

Evaluation of the Relationship Between Platelet Indices and Mitral Restenosis After Percutaneous Mitral Balloon Valvuloplasty

Background: Percutaneous mitral balloon valvuloplasty (PMBV) has been established as an effective and safe treatment modality for symptomatic patients with severe rheumatic mitral stenosis. While Wilkin Score (WS) ≤ 8 are associated with higher rates of procedural success and lower rates of restenosis, higher WS are associated with lower rates of procedural success and higher rates of restenosis. It is well known that platelets have substantial role in thromboembolic complications of rheumatic mitral stenosis and various studies showed that increased platelet (PLT) activity in rheumatic mitral stenosis. The aim of this study was to assess the usefulness of PLT indices as a predictor of restenosis in patients who underwent PMBV. Methods: We retrospectively enrolled 178 consecutive patients who underwent PMBV. Patients were classified into the two groups. Study group (n=21) included patients whom we performed redo PMBV during their follow-up as a result of mitral restenosis following previous PMBV (index procedure) and control group (n=157) included patients whom did not undergo a redo PMBV. PLT indices including PLT count, Platelecrit and mean platelet volume values were evaluated in these groups. Results: In study group, PLT count (210 ± 49 vs. 241 ± 62, p=0.010), PCT [0.203 (0.173-0.230) vs. 0.260 (0.243-0.290), p

Is mitral balloon valvuloplasty really innocent?: A case report of right ventricular rupture

Is mitral balloon valvuloplasty really innocent?: A case report of right ventricular rupture

Left atrial structural and functional remodeling following balloon mitral valvuloplasty.

Mitral stenosis (MS) is associated with left atrial (LA) functional and morphological changes as a result of chronic increase in LA pressure. Relieving the mitral obstruction via balloon mitral valvuloplasty (BMV) might be associated with LA structural and functional remodeling. To study alterations of LA volume and functions 1 year following successful BMV in patients with isolated rheumatic severe mitral stenosis. Thirty patients (median age 33 years, 22 women) with severe rheumatic MS were included in the study. Using biplane method, trans-thoracic 2D echocardiography was used to estimate LA volume indexed to body surface area (BSA). Maximal, minimal and pre-A left atrial volumes were measured and indexed to BSA. LA volumetric functions were then assessed and the measurements were repeated 6 months and 1 year after successful valvuloplasty. At baseline, median mitral valve area (MVA) was 0.9 (0.6-1.3)cm2 measured by planimetry with a mean pressure gradient of 12.5 (8-24)mmHg. Following BMV, a significant regression of left atrial volume index was noticed at 6 months compared to baseline (51 vs. 60ml/m2, p = 0.001) with a further decrease at 1 year (48 vs. 51ml/m2, p = 0.03). At 6 months, volumetric assessment of left atrial functions showed a significant improvement in LA total emptying fraction (42% vs 30%, p = 0.001) as well as in LA passive emptying fraction (26% vs 14%, p = 0.033) and LA active emptying fraction (20% vs. 18%, p = 0.016). All these indices showed further improvement at 1 year [47% (P = 0.02), 29% (p = 0.03) and 31% (p = 0.001) respectively]. In patients with isolated rheumatic MS, mitral valvuloplasty was associated with a significant decline of LA volume accompanied by a significant improvement of its volumetric functions.

Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis.

The objective of this study was to systematically review the maternal and fetal outcomes in pregnant women who underwent percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy. A search was conducted on MEDLINE and Embase databases to identify studies published between 2000 and 2018 that reported on maternal and fetal outcomes following PBMV performed in pregnancy. Randomized controlled trials, cohort studies, case-control studies, cross-sectional studies and case series with four or more pregnancies in which PBMV was performed during pregnancy were included. Reference lists from relevant articles were also hand-searched for relevant citations. A successful procedure was defined as one where there was a reported improvement in the valve area or reduction in the mitral valve gradient. A random effects model was used to derive pooled estimates of various outcomes and the final estimates were reported as percentages with a 95% confidence interval (95% CI). Twenty-one observational studies reporting 745 pregnancies were included in the review, all of them having reported outcomes without a comparison group. Most of the studies fell into the low-risk category as determined using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. Most of the studies (86%) were reported from low- to middle-income countries and PBMV was mostly performed during the second trimester of pregnancy. Forty-three procedures (5.7%) were unsuccessful, nearly half (n=19) of them reported among women with the severe subvalve disease (Wilkins subvalve score 3 or more). There were 11 maternal deaths among those with suboptimal valve anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation was the most common cardiac complication (12.7%; 95% CI 7.3%-19.1%), followed by restenosis (2.4%; 95% CI 0.02%-7.2%). Pooled incidence of cesarean section was 12.1% (95% CI 3.6%-23.8%), preterm delivery 3.9% (95% CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birthweight 5.4% (95% CI 0.2%-14.7%). PBMV may be an effective and safe procedure for optimizing outcomes in pregnant women with mitral stenosis in the absence of severe subvalve disease.

Percutaneous mitral balloon valvuloplasty. Single versus Inoue balloon. long term follow-up

Abstract Introduction The single balloon (SB) is the less expensive technique to perform mitral balloon valvuloplasty (MBV). Objectives: This study aimed to demonstrate that MBV with the Balt single (BSB) and Inoue ballon, the wordwire accepted technique, had similar outcome and long-term follow-up (FU). Methods From 1987 to 2013, 526 procedures were performed, being 312 with a FU, 56 (17,9%) with Inoue balloon (IB) and 256 (82,1%) with BSB. The mean FU 156±144 months, p&amp;lt;0.0001. Univariate analysis (UA) and multivariate Cox analysis (MCA) to determine independent predict variables of survival and event free survival (EFS) of death, cardiac surgery and new MBV, in both techniques groups. Results In IB and BSB groups there were, respectively: female 42 (75.0%) and 222 (86.7%); mean age 37.3±10.0 (19 to 63) and 38.0±12.6 (13 to 83) years, p=0.7138; sinus rhythm 51 (91.1%) and 215 (84.0%), p=0.1754; echo score (ES) 7.6±1.3 (5 to 10) and 7.2±1.5 (4 to 14) points, p=0.0528; echo mitral valve area (MVA) pre-MBV 0.96±0.18 and 0.93±0.21 cm2, p=0.2265; post-MBV mean MVA (Gorlin) were 2.00±0.52 and 2.02±0.37 cm2, p=0.9554; MBV dilatation área 6,09±0,27 and 7,02±0,30, p&amp;lt;0,0001. At the end of the FU, there were in IB and BSB groups, respectively: echo MVA 1.71±0.41 and 1.54±0.51 cm2, p=0.0552; new severe mitral regurgitation in 5 (8.9%) and 17 (6.6%) patients, p=0.5633; new MBV in 1 (1.8%) and 13 (5.1%), p=0.4779; mitral valve surgery in 3 (5.4%) and 27 (10.4%), p=0.3456; deaths 2 (3.6%) and 11 (4.3%), p=1.000; cardiac deaths 1 (1.8%) and 9 (3.5%), p=1.000; ME 5 (8.9%) and 46 (18.0%), p=0.1449. In UA and MCA the BSB or IB technique do not predict survival or EFS. The independent risk factors to survival were: age &amp;lt;50 years (p=0.016, HR=0.233, 95% IC 0.071- 0.764), ES ≤8 (p&amp;lt;0.001, HR=0.105, 95% IC 0.34–0.327), MBV dilatation area (p&amp;lt;0.001, HR 16.838, 95% IC 3.353–84.580) and no mitral valve surgery in the FU (p=0.001, HR0.152, 95% IC 0.050–0.459). Independent risk factors to EFS: no prior commissurotomy (p=0.012, HR=0.390, 95% IC 0.187–0.813) and post-MBV MVA ≥1.50 cm2 (p=0.001, HR=7.969, 95% IC 3.413–18.608). Conclusion In 25 years, survival and EFS were similar in BSB and IB technique. Independent predictors of surviva: age &amp;lt;50 years, ES≤8 points, MBV dilatation area &amp;gt;7 mm2 and no mitral valve surgery in the FU. Independent predictors of EFS: no prior commissurotomy and post-MBV MVA≥1.50 cm2 Funding Acknowledgement Type of funding source: None

Prior surgical mitral commissurotomy and echocardiographic score influence in mitral balloon valvuloplasty. Immediate post procedure results

Abstract Introduction Percutaneous mitral balloon valvuloplasty is effective in mitral stenosis. Objectives: to evaluate prior mitral surgical commissurotomy (PMC) and echocardiographic score (ES) in the results and complications of mitral balloon valvuloplasty (MBV). Methods From 1987 to 2013, 526 procedures with Inoue balloon, double or single Balt balloon technique; 480 without PMC named primary MBV group (PMBVG) and 46 that have been submitted to PMC, the PMC group. The PMCG was older than PMBVG (42.7±12.4 vs 36.9±12.5 years, p=0.0030). Gender, atrial fibrilation and NYHA functional class were similar. In PMBVG and PMCG, respectively, ES were 7.2±1,4 and 7.7±1.5 points (p=0.0158) and mitral valve area (MVA) 0.94±0.21 and 1.00±0.22 cm2 (p=0.0699). Results Pre-MBV: mean pulmonary artery pressures (MPAP) were 37.8±14.2 and 37.6±14.4 mmHg, p=0.9515; mean gradient (MG) 19.6±6.9 and 18.3±6.9 mmHg, p=0.2342; MVA 0.90±0.21 and 0.93±0.19 cm2, p=0.4092, respectively, whem compare PMBVG and PMCG. Post-MBV: MPAP were 26.8±10.2 and 26.6±10.9 mmHg, p=0.9062; MG 5.4±3.5 and 6.3±4.2 mmHg, p=0.1492; MVA 2.04±0.42 and 1.92±0.41 cm2, p=0.0801, respectively. Mitral regurgitation (MR) were similar pre and post-MBV. Severe MR post-MBV in 10 patients: 8 in PMBVG and 2 in PMCG, p=0.2048. As there were not found significant diferences, the total group were divided in ES ≤8 and &amp;gt;8 groups: Pre-MBV: MPAP 37.5±13.9 and 39.3±16.6 mmHg, p=0.4041; MG 19.7±6.8 and 18.3±7.3 mmHg, p=0.1753; MVA 0.90±0.21 and 0.94±0.20 cm2, p=0.0090 respectively. Post-MBV: MPAP 26.7±10.1 and 28.0±10.6 mmHg, p=0.3730, MG 5.5±3.6 and 5.5±3.3 mmHg, MVA 2.06±0.42 and 1.90±0.40 cm2, p=0.0090. Conclusion The groups with and without prior mitral commissurotomy in MBV were compare and no differences were found in pre- and post-procedure, as mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Although PMCG was older, with higher ES, its hemodynamics datas were similar. Whem the entire group was divided based on echo scores, those with echo scores &amp;gt;8 had highse MV (p=0.0090). and smaler mitral valve areas post-valvuloplasty. The valve anatomy were more important than prior commissurotomy. Funding Acknowledgement Type of funding source: None

Surgical rheumatic mitral valve repair compared with percutaneous balloon mitral valvuloplasty in mitral stenosis in current era: a propensity score matching study.

BackgroundMany comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with “four-step” procedure in the treatment of rheumatic MS.MethodsPatients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences.ResultsA total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP. Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm2, P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively. Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent re-intervention in rMVP, but one patient died of pneumonia.ConclusionsFor selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with “four-step” procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).

Percutaneous mitral balloon valvuloplasty - state of the art

Since its introduction in 1982, percutaneous mitral balloon valvuloplasty (PMV) has been used successfully as an alternative to open or closed surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. PMV is safe and effective and provides sustained clinical and hemodynamic improvement in patients with mitral stenosis. The immediate and long-term results appear to be similar to those of surgical mitral commissurotomy. Proper patient selection is an essential step for being able to predict the immediate results of PMV. Candidates for PMV require precise assessment of the mitral valve morphology. The Wilkin’s echocardiographic score (Echo-Sc) is currently the most widely used method for predicting PMV outcome. Leaflet mobility, leaflet thickening, valvular calcification, and sub valvular disease are each scored from 1 to 4. An inverse relationship exists between the Echo-Sc and PMV success. Both immediate and intermediate follow-up studies have shown that patients with Echo-Sc ≤ 8 have superior results, significantly greater survival, and event free survival compared to patients with Echo-Sc &gt; 8. We identified other clinical and morphologic predictors of PMV success that include age, pre-PMV mitral valve area, history of previous surgical commissurotomy, and mitral regurgitation (MR), and post-PMV variables (e.g., post-PMV MR ≥ 3 + and pulmonary artery pressure), that may be used in conjunction with the Echo-Sc to optimally identify candidates for PMV. This concept demonstrates a multifactorial nature of the prediction of immediate and long-term results. Other echocardiographic scores have been developed for the screening of potential candidates for PMV. They include a unique score that take into account the length of the chordae. A novel quantitative score that included the ratio of the commissural areas over the maximal excursion of the leaflets from the annulus in diastole. The components of this score include mitral valve area ≤ 1 cm2, maximum leaflet displacement ≤ 12 mm, commissural area ratio ≥ 1.25, and sub valvular involvement. Finally, a score that is able to identify patients who are more likely to develop significant mitral regurgitation post-PMV. This score takes into account the distribution (even or uneven) of leaflet thickening and calcification, the degree and symmetry of commissural disease, and the severity of subvalvular disease. The transvenous transseptal approach is the most widely used PMV technique. The two major techniques of PMV are the double-balloon technique and the Inoue technique which are equally effective techniques of PMV. Encouraging results of PMV have been reported in special mitral stenosis population cohorts including pregnant women, patients with previous surgical commissurotomy, patients with atrial fibrillation, patients with pulmonary hypertension, elderly patients, patients with calcific mitral stenosis, and patients with associated aortic regurgitation. To summarize, PMV is the preferred form of therapy for relief of mitral stenosis for a selected group of patients with symptomatic mitral stenosis and suitable valve anatomy for valvuloplasty. Patients with Echo-Sc ≤ 8 have the best results, particularly if they are young, are in normal sinus rhythm, have no pulmonary hypertension, and have no evidence of calcification of the mitral valve under fluoroscopy. The immediate and long-term results of PMV in this group of patients are similar to those reported after surgical mitral commissurotomy. Patients with Echo-Sc &gt; 8 have only a 50% chance to obtain a successful hemodynamic result with PMV, and the long-term follow-up results are worse than those from patients with Echo-Sc ≤ 8. In patients with Echo-Sc ≥ 12, it is unlikely that PMV could produce good immediate or long-term results and they preferably should undergo mitral valve replacement. However, PMV could be considered in these patients if they are high-risk or unqualified surgical candidates.

Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association.

The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.

TO STUDY THE EFFECT OF BMV ON P WAVE DISPERSION AND SHORT TERM PROGNOSTIC IMPACT OF P WAVE DISPERSION IN PREDICTION OF CLINICAL OUTCOME AFTER PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY IN PATIENTS WITH MITRAL STENOSIS AND SINUS RHYTHM

Background: The aim of the present study was to study the effect of percutaneous balloon mitral valvuloplasty (PBMV) on P wave dispersion and to test the correlation between P-maximum and P-dispersion to right ventricular function and pulmonary artery pressure before and after PMBV. Also to study the impact of P-maximum and P-wave dispersion on the short term clinical outcome after successful PBMV in patients with mitral stenosis (MS) and sinus rhythm.&#x0D; Methods: 75 patients undergoing PMBV were enrolled in this study. We evaluated P-maximum, P-minimum and P-wave dispersion before and one month and one year after PBMV . We studied the changes in pulmonary arterial pressure (PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve area, in addition to the changes in right ventricular function utilizing tissue Doppler assessment both before and after PMBV, in addition the role of the P-wave dispersion in prediction of late cardiac events.&#x0D; Results: There were significant decrease in mean diastolic gradient, PAP, and LA size and significant improvement in right ventricular tissue Doppler indices after PMBV. Accompany these hemodynamic changes after PMBV. P-maximum and P-wave dispersion were found to be decreased (P &lt; 0.001).&#x0D; Conclusion: Successful PBMV was associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV. The P-maximum and P-wave dispersion changes were correlated with significant impairment of right dysfunction and the degree of pulmonary artery pressure.&#x0D; Keywords: PBMV.PAP,LA