Balloon Mitral Valvuloplasty Research Articles

Left and right ventricular deformation in patients with severe mitral stenosis and pulmonary hypertension undergoing percutaneous balloon mitral valvuloplasty: A two dimensional speckle-tracking echocardiographic study

Seventy-five patients with isolated severe MS (mitral valve area: 1.10 ± 0.15 cm2) and pulmonary hypertension underwent regional and global longitudinal strain (GLS) measurements of left (LV) and right ventricle (RV) at baseline and within 48 h after percutaneous balloon mitral valvuloplasty (PBMV). PBMV resulted in significant improvement in LV GLS (−16.35 ± 1.67% vs −19.98 ± 2.17%) and RV GLS (−10.34 ± 2.38% vs −13.83 ± 2.04%), p < 0.001 for both. Absolute increase in strain of basal segments of LV was more compared to mid and apical segments. We also found significant positive correlation between decrease in mean LA pressure (pre PBMV 28.91 ± 4.21 mm Hg vs post PBMV 10.55 ± 3.04 mm Hg, difference of 16.36 mm Hg; p < 0.001) obtained invasively during PBMV for 62 patients with improvement in LV GLS (r = 0.257, p = 0.048), RV GLS (r = 0.267, p = 0.043), and fall in right ventricular systolic pressure (r = 0.308, p = 0.022) that occurred post PBMV. The LV dysfunction is predominantly because of altered hemodynamics due to restricted LV filling with additional contribution from rheumatic involvement of basal LV myocardial segments. The improvement in LV deformation after PBMV is likely due to increase in preload. RV afterload reduction because of LA pressure decrease improved RV deformation.

Rheumatic heart disease anno 2020: Impacts of gender and migration on epidemiology and management.

BackgroundThe epidemiology and management of diseases can be influenced by social demographic factors. Gender and migration are among these factors.MethodsWe aimed at reviewing the impacts of gender and migration on rheumatic heart disease (RHD) epidemiology and management by a nonsystematic literature review of published studies on RHD worldwide. Our PubMed search terms included RHD pathophysiology, diagnosis, complications, management or prevention, combined with words ‘rheumatic mitral stenosis (MS)’, ‘outcomes after percutaneous balloon mitral valvuloplasty (PBMV)’, ‘gender or sex difference’ and ‘migration’. The reporting of this study conforms to SANRA (the Scale for Assessment of Narrative Review Articles) guidelines.ResultsWe retrieved eight studies about the impact of sex on outcomes after PBMV. All of these studies showed a female predominance for RHD. Two studies showed that there is no impact, three studies showed female sex as a predictor of poor outcomes, and the other three showed male sex a predictor of poor outcomes. Although RHD is reported to be eradicated in the developed countries, 2.1% of refugees recently screened for RHD in Italy were found to have subclinical RHD. This prevalence is similar to those found in India (2.0%), Cambodia (2.2%) and Mozambique (3%).ConclusionsThere are contradicting results for outcomes after PBMV between males and females. It is not clear whether sex difference plays a role in pathophysiology, diagnosis, management and prognosis of MS. Migration has impacts on epidemiology and management of RHD. Further studies are required in these two fields to explore their relationship to RHD.

Cardiac operation and interventional therapy during pregnancy： an analysis of outcome

Objective: To explore the efficacy and safety of open cardiac operation and interventional therapy in pregnant patients and describe the feto-neonatal and maternal outcomes. Methods: A retrospective study of 39 cases of women undergoing open cardiac operation or interventional therapy during pregnancy was conducted in Guangdong Provincial People's Hospital from Jan. 2014 to Oct. 2019. Results: The age of 39 pregnant women with gestational heart disease was (30±6) years old (21-43 years old). Among them, 37 cases were single and 2 cases were twin pregnancy. Modified World Health Organization (mWHO) pregnancy risk classification were all level Ⅳ. There were 22 women receiving cardiac operation under cardiopulmonary bypass during pregnancy, 14 patients undergoing percutaneous balloon mitral valvuloplasty, 2 patients accepting percutaneous balloon pulmonary valvuloplasty, and 1 case receiving atrial septal defect occluder with ultrasound guidance. Three were no maternal deaths during and after the operation. One patient had an inevitable abortion. Four fetuses died in the uterine after open cardiac surgery. There patients chose termination of the pregnancy after cardiac operation. There were 31 live birth, in which 7 cases were preterm live birth and 24 patients were term live birth. The total number of newborns were 33. Two fetuses suffered neonatal intracranial hemorrhage and died after birth. Thirty-one fetuses were alive and born without any abnormity. Conclusion: For pregnant women with high risk of cardiovascular disease and classified as mWHO pregnancy risk level Ⅳ, cardiopulmonary bypass and interventional therapy during pregnancy could be used as an alternative for better materal and fetal outcomes.

Mitral leaflet separation index for mitral valve assessment during balloon mitral valvuloplasty.

The objective of the study was to evaluate the accuracy of the mitral leaflet separation index (MLSI) in selected patients with mitral stenosis, before and after percutaneous balloon mitral valvuloplasty (PBMV), compared to conventional methods with transthoracic echocardiography [TTE]. A prospective study was conducted in 30 patients, ages 20-60years, with severe symptomatic mitral stenosis (MS) who had PBMV in the Cardiology Department, Zagazig University and National Heart Institute. A mean of three to five measurements of MLSI was taken in diastole in the parasternal long-axis and apical four-chamber views. The MLSI was re-measured 24-48hours after PBMV. We calculated the correlation of the MLSI, pre and post BMV, with two-dimensional (2D) MV planimetry and pressure half-time (PHT) methods to assess MVA. There was a positive, highly significant correlation between pre PBMV 2D planimetry and MLSI (r=.665, P-value<.001) as well as post PBMV 2D planimetry and MLSI (r=.410, P-value=.025). A positive highly significant correlation was also noted between pre PBMV PHT and MLSI (r=.678, P-value <.001) and between post PBMV PHT and MLSI (r=.706, P-value <.001). Mitral leaflet separation index is an easy and reliable measurement for the assessment of mitral stenosis before and after PBMV.

A novel technique for percutaneous mitral balloon valvuloplasty.

A novel technique for percutaneous mitral balloon valvuloplasty.

Acute and short term effects of successful mitral valvuloplasty on net atrio ventricular compliance and its correlation with clinical outcome

Aim of the studyPatients undergoing successful balloon mitral valvuloplasty (BMV) have variable improvement in New York Heart Association (NYHA) functional class (FC), exercise capacity (EC) and regression of systolic pulmonary artery pressure (sPAP). Improvement in net atrioventricular compliance (Cn), one of the major determinants of above factors is not routinely assessed. Aim of present study was to assess the change in Cn after successful BMV and its correlation with above factors. Methods50 patients of very severe mitral stenosis in sinus rhythm who underwent successful BMV have been studied. NYHA FC, 6 min walk test (6 MWT) and echocardiographic evaluation was done 24 h before and at 2 weeks, 12 weeks and 24 weeks after BMV. Echocardiographic parameters of patients with improvement in NYHA class of ≥2 (group A) were also compared with those with improvement in NYHA class of ≤1 (group B). ResultsFollowing successful BMV, there was progressive improvement in Cn upto 12 weeks with no further significant improvement till 24 weeks. Change in Cn showed very good correlation with change in NYHA class [r = 0.62, p < 0.01], 6 MWT [r = 0.30, p0.03] and regression of sPAP assessed at 12 weeks and was maintained upto 24 weeks. Change in MVA did not show any correlation with above factors. Group B patients had significantly lower Cn post BMV as compared to group A patients inspite of comparable MVA and trans valvular gradients. ConclusionImprovement in Cn following BMV has good correlation with clinical improvement. So Cn should also be assessed along with MVA to better predict clinical outcome.

Left Atrial Appendage (LAA) Function by Transesophageal Echocardiography before and after Percutaneous Balloon Mitral Valvuloplasty (PBMV)- A Comparative Study

Background: In the past, the left atrial appendage (LAA) has been considered to be a relatively insignificant portion of cardiac anatomy. It is now recognized that it is a structure with important pathological associations. First, thrombus has a predilection to form within the LAA in patients with non-valvar atrial fibrillation and to a lesser extent in those with mitral valve disease (both in atrial fibrillation and in sinus rhythm). Second, the use of transoesophageal echocardiography has made clear imaging of the LAA possible, so that its size, shape, flow pattern, and content can be assessed in health and disease. Subjects and Methods: This study population consisted of 40 patients with symptomatic mitral stenosis who underwent percutaneous mitral balloon valvotomy in the cardiology department of GSL medical college, Rajahmundry over a time period of 1 April 2017 to 30 March2018. Patients in all age groups, with evidence of severe MS (MVA&lt;1.0cm2) admitted in our institution, in whom PBMV was feasible were included. Those who were fulfilling the PBMV intervention criteria and those who had good results only were included. Results: Left atrial appendage late emptying velocity, LAALF: Left atrial appendage late filling velocity Spontaneous echocontrast (SEC) was present in 10 of the 40 patients before a procedure but completely disappeared (6 patients) or decreased (4 patients) after the procedure. LAALE &amp; LAALF velocities measured by Doppler were increased significantly after PBMV and at 6 months follow up compared with baseline (P &lt;0.001). Conclusion: Successful Percutaneous balloon mitral valvotomy decreases the intensity of spontaneous LA contrast, reduces the size of the LA, and improves LA and LAA function. Relief of MS may confer not only hemodynamic benefits for improvement of symptoms but also have a favorable influence on future thromboembolism.

Evaluation of the effect of percutaneous mitral balloon valvuloplasty on left ventricular systolic functions using strain and strain rate echocardiography

Background/aimThis study aimed to evaluate the effect of successful percutaneous mitral balloon valvuloplasty (PMBV) on left ventricular systolic functions using strain and strain rate echocardiography in moderate–severe mitral stenosis (MS) patients with normal left ventricular systolic function confirmed by conventional echocardiography. Materials and methodsPatients with moderate–severe MS who had undergone successful PMBV were included. Conventional echocardiographic parameters were evaluated before and after PMBV. Peak systolic strain and strain rate values of basal, mid, and apical segments of the left ventricular anterior, inferior, septum, and lateral walls were determined. ResultsAfter PMBV, significant decreases were determined in the peak and mean gradients of the mitral valve and pulmonary artery pressure, but a significant increase in the mitral valve area. Significant increases (improvement) were determined in the peak systolic strain and strain rate in the basal, mid, and apical segments of the left ventricular septum, lateral, anterior, and inferior walls and in the left ventricular global peak systolic strain (–17.32 ± 0.58% vs. –12.38 ± 1.06%) and strain rate (–1.65 ± 0.07 vs. –1.22 ± 0.12). ConclusionStrain and strain rate echocardiography can be used for quantitative evaluation of the effect of PMBV on the left ventricular systolic functions in moderate–severe MS patients.

Vacuuming the LAA: Left Atrial Appendage Thrombectomy Using AngioVac to Facilitate Percutaneous Mitral Balloon Valvuloplasty

A 63-year-old woman with known severe rheumatic mitral stenosis presented with new-onset atrial fibrillation (AF) with rapid ventricular response. Her hospital course was complicated with thromboph...

Impact of balloon mitral valvuloplasty on left ventricular rotational deformation: Magnetic Resonance Imaging follow up study.

In patients with rheumatic mitral stenosis (MS), some previous studies have investigated the influence of balloon mitral valvuloplasty (BMV) on left ventricular (LV) systolic function. However, the impact of BMV on LV twisting motion in this clinical setting has not been studied before yet. To describe changes in LV torsion in patients with rheumatic MS following BMV. Thirty patients (median age 33years, 22 women) with isolated severe MS were studied. CMR myocardial tissue tagging was used for assessment of LV rotational deformation. LV torsion was calculated as the twist value (the net difference between apical counterclockwise and basal clockwise rotation) normalized to the length of the ventricle and multiplied by the mean radius at the base and apex. All patients had CMR studies before, 6months and 1year after successful BMV. At baseline, patients had a mitral valve area of 0.9 (0.6-1.3) cm2, mean pressure gradient of 12.5 (8-24) mmHg across the valve as measured by transthoracic echocardiography. Median LV ejection fraction (LVEF) estimated by CMR was 57 (range: 45-69) %. A significant improvement in LV base-apex torsion was shown at 6months (3.3° vs. 2.5°, p < 0.001) with a further improvement at 1year (4.1° vs. 3.3°, p = 0.05). Similar pattern of change was seen in LV base-mid torsion with a significant increase at 6months (3.6° vs. 2.3°, p < 0.001) and a further increase at 1year (4.7° vs. 3.6°, p = 0.007). These changes were associated with a significant increase in LVEF (62% vs. 57%, p < 0.001) at 1year following BMV. Successful BMV is associated with a significant improvement in LV torsion that is accompanied by a significant improvement in LVEF.

A Novel Hypothetical Method to increase the Dimensions of the Coronary Arteries when Required

Background: The purpose was to develop a novel hypothetical method to increase the size of coronary arteries.Methods: During long-term observation an increase in coronary size has been seen in three unexpected scenarios. Changes in coronary artery sizes were observed in patients with mitral stenosis (n=69) by angiogram prior to percutaneous balloon mitral valvuloplasty or valve replacement surgery for severe mitral stenosis. The coronaries of patients with patent ductus arteriosus who underwent surgical closure in the past (n=14) were examined by echocardiogram. Patients with renal failure on long-term dialysis through peripheral arterio-venous fistula without left ventricular hypertrophy (n=17) were studied by echocardiography. Normal age, weight and sex matched coronary sizes served as controls in the study. All these observations were made over a period of 12 years.Results: The sizes of coronaries in patients with mitral stenosis, patients who underwent closure for patent ductus arteriosus, and in patients on hemodialysis through arteriovenous fistulas were higher than normal controls (p&lt;0.05, for all). A hypothetical model to increase the coronary sizes could be developed based on the analysis of the differential equations of Poiseuille’s. A method is proposed of creating a peripheral arterio-venous fistula, which could be closed later electively by a percutaneous method/surgery. The closure time needs to be determined by experimental studies. The other methods could be a continuous exercise program or by the use of beta-blockers.Conclusion: A novel hypothetical method of peripheral arteriovenous fistula formation is decsribed which could potentially increase the size of the coronaries, which could be closed later.

Predictors of Complications During Percutaneous Multitrack Balloon Mitral Valvuloplasty

Introduction: Mitral Stenosis (MS) is characterized by a decrease in Mitral Valve (MV) orifice area leading to compromised left ventricular filling. The consequence is stagnation of blood proximal to the MV that results in elevated left atrial, pulmonary venous, and pulmonary artery pressure. Aim of the work: Trace the complication of mitral regurgitation during the procedure percutaneous Balloon Mitral Valvuloplasty (PMV) by using multitrack balloon. Subjects and methods: This interventional non-randomized cohort study was conducted on 121 patients who presented with moderate to severe MS and subjected to PMV using multitrack balloon technique and were divided into 2 groups, according to resultant mitral regurgitation: Group A: included patients with no or mild mitral regurgitation and Group B: included patients with severe mitral regurgitation. Results: Multivariate regression identified MV balloon sizing (OR 3.877, CI 95% 1.131-13.289, P value 0.031), MV commissural asymmetry (OR 67.48, CI 95% 5.759-790.72, P value 0.001). Conclusion: Mitral valve calcification, balloon sizing and MV asymmetry are significant factors that can predict the development of severe MR after balloon valvuloplasty.

Pansitopeni ve Karaciğer Yetmezliği Olan Mitral Stenozu Hastasında Güvenli Bir Tedavi Modalitesi Olarak Perkütan Mitral Balon Valvüloplasti

Pansitopeni ve Karaciğer Yetmezliği Olan Mitral Stenozu Hastasında Güvenli Bir Tedavi Modalitesi Olarak Perkütan Mitral Balon Valvüloplasti

Balloon Mitral Valvotomy in Gestational Women with Symptomatic Mitral Stenosis

Background: Rheumatic valvular heart disease, commonly mitral stenosis, complicate 1% of pregnancies. Balloon mitral valvuloplasty (BMV) is an established treatment of rheumatic mitral stenosis. Aim of the study was to assess the safety and efficacy of Balloon mitral valvuloplasty in pregnant women with severe mitral stenosis.&#x0D; Materials and Methods: 66 patients who failed to respond to medical therapy undergoing BMV during pregnancy were analysed in this retrospective study. Mitral valve area (MVA), transmitral Mean valve gradient (MVG), and mitral regurgitation (MR), Pulmonary artery pressure (PAP) were assessed before and 24 hours after the procedure by transthoracic echocardiography. Patients were followed up to one month post BMV and neonates were monitored for the adverse effect of radiation. &#x0D; Results: Mitral valve area increased from 0.83 ± 0.13 cm2 to 1.38 ± 0.29 cm2 (P = 0.007). Mean gradient mitral valve gradient decreased from 15.5 ± 7.4 mmHg to 3.36 ± 2.36 mmHg (P = 0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 (P = 0.012). No maternal death, intrauterine growth restriction was observed.&#x0D; Conclusion: Balloon mitral valvuloplasty has favourable immediate good outcomes for mothers and newborns.

Percutaneous balloon mitral valvuloplasty in pregnant patients with rheumatic mitral stenosis: A ten-year single-center experience

Rheumatic mitral Stenosis is a common issue in Tunisia causing significant morbidity and mortality. Women with severe mitral stenosis often do not tolerate cardiovascular demands of pregnancy despite medical therapy, with an urgent need to enhance mitral valve area by percutaneous balloon mitral valvuloplasty (BMV). To determine immediate and long-term maternal and fœtal outcomes after BMV during pregnancy. This was retrospective single center experience, analysing data from BMV registry from January 2008 to December 2018. During the study period, 40 pregnant women among a total of 461 patients (9%) underwent BMV for severe mitral stenosis. The mean age was 35 ± 5 years. The mean gestational age was 26 ± 8 weeks. The BMV was successful in 38 out of 40 patients (95%), achieving mitral area > 1.5 cm 2 with a drop in left atrial mean pressure from 30 ± 9 mmHg to 16 ± 5 mmHg. In all successful procedures, patients improved their NYHA status by at least one stage. There was no maternal mortality in our series. One procedure had to be abandoned because of failed septal puncture. One patient developed severe mitral regurgitation secondary to chordae rupture, and had as a consequence emergent valve replacement. Thirty-three patients had a normal delivery while seven patients underwent a caesarean section. We reported a single neonatal death 48 hours after delivery caused by preterm respiratory distress. The BMV permitted a clinical and hemodynamic improvement and allowed the pursuit of pregnancy until end of term in most of cases. On 57-month mean follow-up, there were 3 cases of mitral restenosis, all babies maintained normal growth and development. Percutaneous balloon mitral valvuloplasty was associated with low maternal and fœtal risk and should be considered as the treatment of choice in pregnant women with severe mitral stenosis.

Mitral balloon valvuloplasty followed by closure of the left atrial appendix in presence of thrombi and recurrent stroke

Hemodynamic consequences of mitral stenosis as well as inflammatory and structural changes in the left atrium increase the risk of developing atrial fibrillation and predispose to thrombus formation, primarily in the left atrial appendage. Percutaneous mitral balloon valvuloplasty for hemodynamically severe rheumatic mitral stenosis with favorable valve anatomy reduces the risk of thromboembolic events and stroke. Although the presence of left atrial thrombus is determined as a contraindication, percutaneous intervention has been found to be safe when the thrombus is localized to the atrial appendix. Left atrial appendix occlusion is an alternative treatment of choice for stroke prevention in patients with high stroke risk in whom oral anticoagulation is contraindicated or in patients with thromboembolic events in spite of adequate anticoagulation. Here we report a case of a 91-year-old-woman with very severe mitral stenosis and chronic atrial fibrillation, with a left atrial appendix thrombus and a history of recurrent stroke despite warfarin. Balloon valvuloplasty was performed firstly without encountering any embolic events. The thrombus was dissolved following restored of the left atrial flow. Subsequently, atrial appendix occlusion device was implanted in order to reduce the risk of recurrent thromboembolic events.

Predictors of Complications during Percutaneous Multitrack Balloon Mitral Valvuloplasty

Background: Percutaneous mitral balloon valvuloplasty is the main procedure in mitral stenosis (MS). It can replace surgical commissurotomy in many cases; however, mitral regurgitation (MR) remains the major procedure complication. Objectives: This study was conducted to investigate predictors of MR as a complication followingpercutaneous mitral valvuloplasty (PMV) using multitrack balloon technique. Methods: This cohort study was conducted at both Menoufia University Hospital and Mabaret Misr Elkadima Hospital. We enrolled 121 patients with moderate to severe MS who were subjected to PMV using multitrack balloon technique during the period from October 2017 to October 2019. Transthoracic echocardiographic evaluation was performed for all patients before and after the procedure. Patients who developed severe MR post procedure were compared with other patients to identify important distinction points. Results: Most patients (N = 109, 90.1%) developed no/mild MR (group A), whereas 12 (9.9%) patients developed severe MR (group B) after PMV. Those who developed severe MR had significantly higher weight, height, body mass index, and body surface area (P value 35.8%, P - 13.289, P = 0.031) and MV commissural asymmetry of calcification (OR 67.48, CI 95% 5.759 - 790.72, P = 0.001) as significant predictors of outcomes of MV commissurotomy. Conclusion: Mitral valve calcification, balloon sizing, and MV asymmetry are significant factors that can predict the development of MR after balloon valvuloplasty.

Assessment of immediate effects of percutaneous balloon mitral valvuloplasty on right ventricular and pulmonary functions in severe rheumatic mitral stenosis patients using speckle tracking echocardiography and spirometry.

Introduction: The current study was sought to assess the immediate effect of percutaneous balloonmitral valvuloplasty (PBMV) on right ventricular (RV) and pulmonary functions using speckle tracking echocardiography (STE) and spirometry respectively. Methods: Two-dimensional speckle tracking and doppler studies for strain and strain rate imaging of RV were performed before PBMV, after 48h and 15 days of PBMV using echocardiography and spirometry. Mitral valve area, peak and mean mitral valve transannular pressure gradients, late filling velocities,Wilkins score, Systolic pulmonary artery pressure, TAPSE, RV end-diastolic and end-systolic areas,RV fractional area change and Tei index were measured. Results: There was a significant rise in peak RV global longitudinal strain (GLS) from baseline to48h post PBMV and at 15 days post PBMV. Segmental RV strain at basal septum, mid septum,apical septum and basal RV free wall showed considerable improvement from baseline to 48h post PBMV and 15 days post PBMV. RV longitudinal strain rate parameters did not show significant improvement after PBMV and remained low at follow-up. Post PBMV all patients showed restrictive features on pulmonary function test. The mean FEV1 (% predicted), mean FVC (% predicted), mean PEFR improved from baseline to 48h PBMV and 15 days post PBMV. Though the mean FEV1/FVC increased post PBMV at 15 days follow-up, but it was statistically insignificant. Conclusion: RV performance in MS was decreased mainly due to increase in RV after load which improves after PBMV. Patients with severe MS have impaired pulmonary function which is of restrictive type and successful PBMV improves pulmonary function.

Transesophageal echo: The time-saver in complications of balloon mitral valvuloplasty

Transesophageal echo: The time-saver in complications of balloon mitral valvuloplasty

Characteristics, aetiology and treatment of valvulopathies in the cardiology department of Ibn Rochd University hospital, Casablanca, Morocco

Valvulopathies represent a clinical entity frequently encountered in daily practice. They must be detected and questioned before having repercussions on the myocardium, so as not to delay a possible surgical intervention. The results of surgery have improved considerably thanks to an earlier diagnosis, hence the importance of early diagnosis of these valvulopathies in our environments. The aim of our study is to estimate the prevalence of valvulopathies and to inventory the main etiologies and treatment. We carried out a prospective, single-centric study from October 2017 to January 2018, concerning the register of patients followed for valvulopathies, collected from the hospital of the valvular day and echocardiography vacations in the department of cardiology of Ibn Rochd University Hospital of Casablanca. 4000 patients consulted in the CHU cardiology department. Of these, 327 had valvulopathy. The average age was 58.2 sex ration = 0.47. The main risk factors identified are smoking (17.6%) and high blood pressure (19.4%). The most frequent reasons for consultation are dyspnea (94%) and palpitations (15%). Electrically 36,5% have ACFA, 16,8% have repolarization disorders and 13.1% have electrical HVG. On echocardiography, there was damage to a single valve (55%), 02 valves (20.1%) or 03 valves (2.7%). Mitral valvulopathies (73.4%) are the most commonly found valvulopathies. Tricuspid disease was noted in 18 patients. The main etiologies are rheumatic (70%) and degenerative. Percutaneous mitral balloon valvuloplasty was performed in 15% of patients with mitral stenosis. Among patients with severe valvular heart disease, surgical treatment was indicated for 112 patients. Valvulopathies are quite common in our context with a female predominance and often of rheumatic origin. Percutaneous mitral balloon valvuloplasty and prosthetic valve replacement are the preferred treatment methods for valvular heart disease.