Percutaneous Balloon Mitral Commissurotomy Research Articles

Comparison of Mitral Valve Repair Versus Percutaneous Mitral Balloon Commissurotomy for Patients With Rheumatic Heart Disease: A Single-Centre Study

Percutaneous mitral balloon commissurotomy (PMBC) is the standard treatment option for patients with rheumatic mitral stenosis (MS), according to current guidelines. This study aimed to compare the outcomes of rheumatic mitral valve repair (rMVR) and PMBC in this patient population. Baseline, clinical, and follow-up data from 703 patients with rheumatic heart disease who underwent PMBC or rMVR at the current centre were collected and analysed. A 1:1 propensity score (PS) matching method was used to balance the differences in baseline characteristics between the two groups. The primary outcome was mitral valve reoperation, and the secondary outcome was all-cause mortality. Propensity score matching generated 101 patient pairs for comparison. In the matched population, there were no significant differences in the early clinical outcomes between the groups. The median follow-up time was 40.9 months. Overall, patients in the rMVR group had a statistically significantly lower risk of mitral valve reoperation than those in the PMBC group (HR 0.186; 95% CI 0.041-0.835; p=0.028). Regarding all-cause mortality, no statistically significant differences were observed between the rMVR and PMBC groups (HR 4.065; 95% CI 0.454-36.374; p=0.210). Compared with PMBC, rMVR has more advantages for the correction of valve lesions; therefore, it may offer a better prognosis than PMBC in select patients with rheumatic MS. However, this finding needs to be verified in future studies with larger sample sizes and longer follow-up periods.

OR13-7 | Intracardiac Echocardiography Guided Percutaneous Mitral Balloon Commissurotomy Case Series: A New Approach to an old Procedure

OR13-7 | Intracardiac Echocardiography Guided Percutaneous Mitral Balloon Commissurotomy Case Series: A New Approach to an old Procedure

Assessment of suitability for percutaneous mitral commissurotomy: a contemporary review of key anatomical criteria and predictive models.

The immediate result of percutaneous balloon mitral commissurotomy is largely determined by the anatomy of the mitral valve complex. Several scores and models have been developed to assess anatomical suitability for percutaneous balloon mitral commissurotomy. Although none has an optimal predictive power, these models look at the valvular apparatus from different perspectives bearing the potential for a complementary role.

TCT-149 Severe Pulmonary Artery Hypertension and Rheumatic Disease: Long-Term Follow-Up After Percutaneous Mitral Balloon Commissurotomy

TCT-149 Severe Pulmonary Artery Hypertension and Rheumatic Disease: Long-Term Follow-Up After Percutaneous Mitral Balloon Commissurotomy

TCT-148 Percutaneous Mitral Balloon Commissurotomy and Restenosis Due to Rheumatic Disease: Single-Center Experience

TCT-148 Percutaneous Mitral Balloon Commissurotomy and Restenosis Due to Rheumatic Disease: Single-Center Experience

Percutaneous Transmitral Commissurotomy - Clinical and Echocardiographic Follow-up in Severe Mitral Stenosis

Objectives: To study the long term clinical and echocardiographic outcomes of percutaneous Trans mitral balloon commissurotomy (PTMC) performed in patients with severe mitral stenosis. Methodology: Total 103 patients were enrolled in this study. Their PTMC procedure was performed between the years 2015 to 2019. Those patients who returned for follow-up in the year 2021 were enrolled. At the time of follow-up their clinical and echocardiographic parameters were recorded. Results: The mean age was 27.44±6.26 years and 97 (94.2%) of them were female. Mitral valve area was improved significantly, planimetry; 0.813±1.39 vs. 1.288±0.21cm2 and PHT; 0.871±0.13 vs. 1.336±0.19 cm2 between baseline and follow-up, respectively. Pressure gradient across mitral valve also improved 7.233±2.81 vs. 14.407±0.92 mmHg between baseline and follow-up, respectively. Pulmonary artery pressures were also reduced significantly 24±0.27 vs. 55±2.41 mmHg as well as the right ventricular systolic pressures 24.4±2.94 vs. 62.34±10.98 mmHg between baseline and follow-up, respectively. At follow-up, 70.9% had NYHA I class, 16.5% had NYHA II class, 11.7% had NYHA III class, and 1% had NYHA IV class compared to 6.8%, 5.8%, 33.9%, and 53.4% pre-procedure, respectively. Conclusion: Long term follow-up of patients after PTMC showed satisfactory outcomes both clinically, as evident from improvement in NYHA functional class, and from echocardiographic stand point with sustained increase in mitral valve area over the period of years. Overall the results of PTMC performed in patients with severe mitral stenosis are satisfactory.

Abstract 11863: Lutembacher Syndrome - Learning From the Left Atrium

Lutembacher syndrome (LS) is a rare cardiac anomaly that was first reported in 1916 by Rene Lutembacher. LS is characterized by an atrial septal defect (ASD) combined with mitral stenosis (MS), both of which can be either congenital or acquired. Without treatment, pulmonary vascular resistance (PVR) steadily increases and can cause right-to-left ASD shunting. This greatly increases the risk of infective endocarditis (IE) and cerebrovascular accidents (CVA). - We present a 69-year-old female with past medical history of laryngeal cancer that presented with dyspnea and hemoptysis. The patient had NYHA class II symptoms and had not undergone prior cardiac work-up. - Transthoracic echocardiogram demonstrated a reduced ejection fraction 35%, calcifies mitral valve leaflets, and abnormal flow across the interatrial septum. Subsequent transesophageal echocardiogram confirmed the diagnosis of Lutembacher Syndrome with a mean mitral valve gradient of 15 mmHg and evidence of a secundum ASD. There was predominant left-to-right shunting during bubble study with transient right-to-left shunt while coughing. Moderate to severe mitral regurgitation and severe pulmonary hypertension was also observed. Wilkins score was calculated at 7. The patient was ultimately transferred to a Comprehensive Valve Center for surgical mitral valve replacement (MVR). - This case highlights the importance of understanding the pathophysiology of LS for efficient diagnosis and appropriate management. Early evaluation at a Comprehensive Valve Center is recommended. Moderate to severe mitral regurgitation is a contraindication to less invasive options such as a percutaneous mitral balloon commissurotomy (PMBC). It is crucial to recognize that after surgical MVR, the secundum ASD is expected to become smaller with predominant left-to-right shunting due to reduced PVR, which decreases the risk of IE and CVA.

Combined atrial fibrillation ablation and balloon mitral commissurotomy in patients with rheumatic mitral stenosis.

Ablation of atrial fibrillation (AF) is usually not considered in patients with rheumatic mitral stenosis (RMS). We analyzed the results of a combined procedure of AF ablation and percutaneous balloon mitral commissurotomy (PBMC). We prospectively included 22 patients with severe RMS to undergo a combined PBMC + AF ablation procedure. Noninvasive mapping of the atria was also performed. A historical sample of propensity-scored matched patients who underwent PBMC alone was used as controls. The primary endpoint was freedom from AF/AT at 1-year. Multivariate analysis evaluated sinus rhythm (SR) predictors. Successful pulmonary vein isolation and electrocardiographic imaging-based drivers ablation was performed in 20 patients following PBMC. At 1-year, 75% of the patients in the combined group were in SR compared to 40% in the propensity-score matched group (p = 0.004). The composite of AF recurrence, need for mitral surgery and all-cause mortality was also more frequent in the control group (65% vs. 30%; p = 0.005). Catheter ablation (odds ratio [OR] 1.58; 95% confidence interval [CI] [1.17-17.37]; p = 0.04) and AF type (OR 1.46; 95% CI [1.05-82.64]; p < 0.001) were the only independent predictors of SR at 1-year. Noninvasive mapping in the combined group showed that the number of simultaneous rotors (OR 2.10; 95% CI [1.41-10.2]; p = 0.04) was the only independent predictor of AF. A combined procedure of AF ablation and PBMC significantly increased the proportion of patients in sinus rhythm at 1-year. Noninvasive mapping may help to improve AF characterization and guide personalized AF treatment.

TCT-408 Mitral Valve Long-Term Restenosis After Percutaneous Mitral Balloon Commissurotomy Due to Rheumatic Mitral Stenosis

TCT-408 Mitral Valve Long-Term Restenosis After Percutaneous Mitral Balloon Commissurotomy Due to Rheumatic Mitral Stenosis

Averted Catastrophic Transseptal Puncture: Percutaneous Transseptal Mitral Commissurotomy in a Patient With Undiagnosed Azygous Continuation of the Inferior Vena Cava

A case is presented of a patient requiring percutaneous mitral balloon commissurotomy. During positioning of the transseptal needle, an unusual needle position on the lateral projection prompted the physician to abandon the puncture and do an angiogram of the inferior vena cava. This revealed an azygous vein continuation. The valve was treated at a later date under general anesthesia with transesophageal echo guidance. This case illustrates how reliance on the posterior-anterior projection to find the optimal point for transseptal puncture can be very misleading and how crucial the lateral projection is.

Immediate maternal and fetal outcome following percutaneous mitral valve balloon commissurotomy: a 6-year single-center experience from sub-Saharan Africa.

Mitral stenosis is the most common valvular heart disease during pregnancy. When severe, it leads to significant maternal and fetal morbidity and mortality. Percutaneous mitral valve balloon commissurotomy can be performed during pregnancy, and the present study aimed to describe the immediate maternal and fetal outcomes after percutaneous mitral valve balloon commissurotomy was done in a cohort of 23 pregnant patients with severe mitral stenosis in Addis Ababa, Ethiopia. Included in the current study were all pregnant mothers who had severe rheumatic mitral valve stenosis and who underwent percutaneous mitral valve balloon commissurotomy at the Cardiac Center of Ethiopia over 6-year period. Data were collected through chart abstraction using a structured proforma and then analysed using STATA version 13.0. Median gestational age was 22 weeks and percutaneous mitral valve balloon commissurotomy was successful resulting in a significant increase in the mean mitral valve area of the group from 0.78 ± 0.20 cm2 to 1.89 ± 0.31 cm2 (p < 0.001). The mean mitral valve inflow gradient of the group was 23.95 ± 6.27 mmHg and 6.80 ± 2.44 mmHg, respectively, before and after the percutaneous mitral valve balloon commissurotomy procedure (p < 0.001). Post-procedure, there was no significant increment in mitral valve incompetence. The mean pulmonary artery pressure of the group decreased from 77.68 ± 23.19 mmHg to 42.31 ± 9.95 mmHg (p < 0.001). There was no fetal or maternal death following the procedure. Pregnancy ended at term gestation for 19/23 (82.6%) of the mothers and the mean birth weight of the neonates was 2800 g. Percutaneous mitral valve balloon commissurotomy procedure can safely be done for severe symptomatic rheumatic mitral stenosis in pregnancy in our setting.

Echocardiographic factors determining immediate results of percutaneous mitral balloon commissurotomy

Define echocardiographic predictors of the immediate results of percutaneous mitral balloon commissurotomy (PMC) PMC by the Inoue balloon was attempted in 247 patients (mean age: 35 ans, 77% female) with severe mitral valve stenosis. All the patients had undergone echocardiographic examination before PMC to assess mitral anatomy, commissural calcification and to determine the Wilkins score. The mean value of Wilkins score was 7,98 ± 1,61(range 5–13) and the mean mitral valve area (MVA) before PMC was 1 ± 0,19 cm 2 (range 0,5–1,4 cm 2 ). Twenty-nine patients (11,7%) had one-commissural calcification. After PMC, the mean MVA increased to 1,79 ± 0,34 cm 2 ( P < 0,001) resulting in a success rate of 83%. Severe mitral regurgitation (MR) occured in 5 patients (2%). Wilkins score was an independent predictor of the immediate result of PMC, but if > 8, this score had a weak predictive value. Commissural morphology was another independent predictor of the immediate result of PMC. Echocardiography is now the cornerstone in the assessment of mitral anatomy before PMC and should integrate Wilkins score and commissural morphology for the optimal selection of patients to PMC.

Percutaneous Transvenous Balloon Mitral Commissurotomy: A Single-Center Experience.

Rheumatic heart disease and its impact on cardiac health is still a concern in developing countries. Percutaneous trans-mitral commissurotomy (PTMC) is the standard of care in managing severe rheumatic mitral stenosis (MS). This article reports a single-center, 10-year real-world experience in Qatar. In this retrospective study, we reviewed all the patients who underwent PTMC in Qatar between January 1, 2012, and January 1, 2022. Periprocedural data were collected at baseline, postprocedural, 1 year, and during the last follow-up. The primary outcome was procedural success (improvement in valve area by 50%, final valve area >1.5 cm2, and freedom from > moderate mitral regurgitation, stroke, or pericardial effusion). Safety endpoints were freedom from death, periprocedural cardiogenic shock and cardiac arrest, stroke urgent mitral valve replacement (MVR), or pericardiocentesis. Long-term outcomes included the requirement of redo PTMC or MVR, in addition to rehospitalization due to arrhythmias, heart failure, or stroke. Sixty-five patients were included in the review (age 42 ± 10, female 38 [58.5%]). Sixty-two patients (95.4%) had a successful procedure. One patient developed a hemorrhagic pericardial tamponade and cardiogenic shock, for which he underwent pericardiocentesis and emergency aortic root repair. One patient developed acute stroke 8 h after the procedure, and one patient had tamponade resolved with emergency pericardiocentesis. Two patients required MVR after 1 and 4 years, respectively. PTMC is the mainstay of rheumatic MS management in patients with suitable anatomy as most patients have excellent outcomes with long-term freedom from surgery, which has been the case in our single-center experience.

Management of mitral stenosis: a systematic review of clinical practice guidelines and recommendations.

A number of guidelines exist with recommendations for diagnosis and management of mitral stenosis (MS). We systematically reviewed existing guidelines for diagnosis and management of MS, highlighting their similarities and differences, in order to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (5/4/2011-5/9/2021), the Guidelines International Network, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two independent reviewers screened titles and abstracts, and the full text of potentially relevant articles where needed. Selected guidelines were assessed for rigor of development; only guidelines with Appraisal of Guidelines for Research and Evaluation II instrument score &gt;50% were included in the final analysis. Four guidelines were retained for analysis. There was consensus for percutaneous mitral balloon commissurotomy as first-line treatment of symptomatic severe rheumatic MS with suitable anatomy. In patients with unfavourable anatomy, surgical intervention should be considered. Exercise testing is indicated if discrepancy exists between symptoms and echocardiographic measurements. There was no clear divide between rheumatic MS and degenerative MS for their respective diagnoses and management. Pregnancy in severe MS is discouraged and the stenosis should be treated before conception. Long-term antibiotic prophylaxis is recommended for patients with rheumatic MS. Recommendations for the management of patients with mixed valvular diseases are lacking.

TCT-197 Independent Clinical and Echocardiographic Predictors of Restenosis After Percutaneous Mitral Balloon Commissurotomy Followed for 24 Years

TCT-197 Independent Clinical and Echocardiographic Predictors of Restenosis After Percutaneous Mitral Balloon Commissurotomy Followed for 24 Years

Mitral Stenosis: Making the diagnosis

The case of a 60-year-old man illustrates a number of important features of rheumatic heart disease (RHD). The patient’s age of presentation was late (&gt;50 yo) and he had no history of predisposing condition for RHD but served in the South Pacific when he was in the US Navy. RHD was limited to mitral stenosis in this patient and his presentation of heart failure was late. His ECG revealed ample evidence of right ventricular enlargement, and echocardiography demonstrated severe mitral stenosis, enlarged right ventricle and right atrium and marked pulmonary hypertension. Because percutaneous balloon mitral valve commissurotomy was precluded by the degree of mitral valve calcification, he underwent successful surgical valve replacement with relief of symptoms. Although RHD is rarely encountered in North America and Europe, it remains a major cause of mortality in the developing nations.

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.

The Outcome of Percutaneous Mitral Balloon Commissurotomy (PMBC) in Pregnant Women with Mitral Stenosis: An Evidence Based Study

Abstract&#x0D; Objective: To review the outcome of percutaneous mitral balloon commissurotomy (PMBC) both to maternal and neonatal.&#x0D; Methods: The search was conducted on Pubmed®, Cochrane Library®, and Ovid® using MeSH. Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by two independent authors.&#x0D; Results: Several studies showed that performing the PMBC had good outcome for pregnant women functional class based on NYHA. Most of them decreased from NYHA III/IV to I/II. For delivery outcome, all studies concluded that more than 80% pregnant women with mitral stenosis undergoing PMBC delivered at term, and no congenital anomalies found.&#x0D; Conclusion: Percutaneous mitral balloon commissurotomy for pregnant women with severe MS is safe during pregnancy.&#x0D; Keywords: mitral stenosis, outcome, percutaneous mitral balloon commissurotomy, pregnancy,&#x0D; &#x0D; Abstrak&#x0D; Tujuan: Mengulas luaran komisurotomi balon mitral perkutan (KBMP) baik pada maternal maupun neonatus.&#x0D; Metode: Pencarian dilakukan melalui Pubmed®, Cochrane Library®, dan Ovid® menggunakan MeSH. Telaah kristis dilakukan oleh 2 penulis independen berdasarkan validitas, kepentingan, dan aplikabilitas.&#x0D; Hasil: Beberapa studi memperlihatkan KBMP memiliki luaran yang baik di kalangan perempuan hamil berdasarkan kelas fungsional NYHA. Kebanyakan mereka mengalami penurunan NYHA dari III/IV menjadi I/II. Untuk luaran persalinan, seluruh studi menyimpulkan lebih dari 80% perempuan dengan mitral stenosis yang menjalani pembedahan KBMP melahirkan pada usia term dan tidak ditemukan kelainan.&#x0D; Kesimpulan: KBMP aman dilakukan pada perempuan hamil dengan mitral stenosis berat.&#x0D; Kata kunci: kehamilan, komisurotomibalon mitral perkutan, luaran, stenosis mitral

Outcomes in pregnant women with rheumatic mitral valve disease after percutaneous mitral balloon commissurotomy

In developing countries, mitral stenosis (MS) is the most common valvular heart disease revealed by pregnancy. Since cardiac surgery is very risky in this case, percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice. We aimed to evaluate the immediate, medium and long-term results of PMC in pregnant women with severe MS. This was a retrospective study that included 20 pregnant women suffering from severe MS, hospitalized in the cardiology department of a tertiary care center, and treated by PMC during last two decades. Mean patients age was 31.5 ± 4.6 years. The PMC was performed on average 27.5 ± 1.8 weeks of pregnancy. Functional improvement was observed immediately after successful PMC. Mitral valve area increased from 1.01 ± 0.1 cm 2 averaged to 1.89 ± 0.3 cm 2 ( P < 0.01). Mean transmitral gradient decreased from 17.9 ± 5.8 mm Hg to 8.05 ± 4.3 mm Hg ( P < 0.01). Systolic pulmonary arterial pressure decreased from 64.85 ± 16.4 mm Hg to 39.15 ± 13.15 mm Hg ( P < 0.01). Mitral regurgitation (MR) increased in nine cases and appeared in eight cases. We noticed no severe MR during the procedure in all cases. Seventeen patients delivered at term. Newborns were all healthy. Four of them had a low birth weight. On the long term follow-up (133.35 ± 77.3 months), five patients had mitral restenosis, one patient underwent a second PMC and the four other patients had a surgical valve replacement. Predictive factors of restenosis were Wilkins score ≥ 8 and partial or absent commissural opening during procedure. These results were comparable to those observed in a population of non-pregnant women who underwent PMC during the same period. It is clear that PMC is an effective technique in the management of MS during pregnancy. The ultimate goal is to improve the hemodynamic situation of the patient in order to pursue the pregnancy and to get better conditions for childbirth.

Rheumatic Mitral Valve Stenosis: Diagnosis and Treatment Options.

This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS). While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented. For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.