Percutaneous Mitral Valvuloplasty Research Articles

Left Ventricular Torsion before and after Percutaneous Mitral Balloon Valvuloplasty

Background: The valve disease is frequently caused by the rheumatic mitral stenosis in developing and developed countries alike and it is still a key issue. Although there is a significant decrease in rheumatic fever diffusion, its percentage is still about 12% of the native valvular heart disease. Aim of Work: The key objective of this work was to assess the impact of percutaneous mitral balloon valvuloplasty (PMBV) on the LV torsion and this objective was achieved by using the two-dimensional speckle-tracking echocardiography. Patients and Methods: The study used the prospective observational method and had been carried out in the Department of Cardiology, Al-Azhar University Hospitals. The treatment group consisted of 35 patients who were candidates for PMBV and the control group consisted of 20 matching patients in terms of gender and age but they were healthy. All the participants of study had been assessed using the conventional echocardiography and speckletracking echocardiography on the previous day and 3 months after the procedure. Results: Using the parameters of the conventional echocardiography, we found that there were no significant differences between the treatment group and the control group in the LV ejection fraction (EF) and RV systolic function (TAPSE) before the PMBV. After applying the Speckle-tracking echocardiography, the results indicated that LV torsion decreased in the treatment group compared to the control group before the PMBV. After 24 hours and 3 months after the PMBV, the patients of treatment group had shown a statistically significant improvement in LV torsion. Conclusion: The LV torsion in MS patients significantly improved immediately and in the short-run follow-up after the PMBV

Left Ventricular Torsion before and after Percutaneous Mitral Balloon Valvuloplasty

Background: The valve disease is frequently caused by the rheumatic mitral stenosis in developing and developed countries alike and it is still a key issue. Although there is a significant decrease in rheumatic fever diffusion, its percentage is still about 12% of the native valvular heart disease. Aim of Work: The key objective of this work was to assess the impact of percutaneous mitral balloon valvuloplasty (PMBV) on the LV torsion and this objective was achieved by using the two-dimensional speckle-tracking echocardiography. Patients and Methods: The study used the prospective observational method and had been carried out in the Department of Cardiology, Al-Azhar University Hospitals. The treatment group consisted of 35 patients who were candidates for PMBV and the control group consisted of 20 matching patients in terms of gender and age but they were healthy. All the participants of study had been assessed using the conventional echocardiography and speckletracking echocardiography on the previous day and 3 months after the procedure. Results: Using the parameters of the conventional echocardiography, we found that there were no significant differences between the treatment group and the control group in the LV ejection fraction (EF) and RV systolic function (TAPSE) before the PMBV. After applying the Speckle-tracking echocardiography, the results indicated that LV torsion decreased in the treatment group compared to the control group before the PMBV. After 24 hours and 3 months after the PMBV, the patients of treatment group had shown a statistically significant improvement in LV torsion. Conclusion: The LV torsion in MS patients significantly improved immediately and in the short-run follow-up after the PMBV

Transesophageal echocardiography and scopy co-guided percutaneous mitral balloon valvuloplasty procedure: Experience of a tertiary health center with a literature review

Objective: Rheumatic valvular heart disease (RVHD) is an important health problem in Turkey, as in all developing countries. There is no exact prevalence data for RVHD in Turkey. But according to the Jones criteria, Turkey has a moderate risk for acute rheumatic fever (ARF). Patients with recurrent bouts of ARF resulting in carditis can progress to RVHD. The aim of this study was to evaluate percutaneous mitral balloon valvuloplasty (PMBV) procedures and compared the findings with the literature. Materials and Methods: PMBV procedure indication was determined according to the guidelines and heart team consensus. Echocardiography was evaluated prior to PBMV in all patients. The study included a total of 131 patients who underwent PMBV in the cardiology clinic of our hospital in the period 2007–2017. All PBMV procedures were performed under intraprocedural transesophageal echocardiography (TEE) guidance in addition to fluoroscopy with general anesthesia. Results: The patients comprised 83% female and 17% male with a mean age of 41.2 ± 10.1 years. Mean ejection fraction was 60.3% ± 3.1%, mean left atrium diameter was 46.7 ± 5.3 mm, and mean Wilkins score was 8.7 ± 1. After procedure with there was no mortality. There was statistically significant increase on mitral valve area and statistically significant decrease on pulmonary arterial pressure and statistically significant decrease on transmitral gradient. Conclusion: This is one of the few studies worldwide to have detected the safety and efficacy of PBMV with TEE and scopy coguidance. It is the first such study in Turkey. In accordance with the literature, the procedures performed with TEE and fluoroscopy co-guidance in our clinic have increased the safety of the procedure and decreased complication rates.

Prognostic Implications of the Left Atrial Volume Index in Patients with Progressive Mitral Stenosis.

BACKGROUNDLimited data are available on the prognosis of progressive mitral stenosis (MS). We evaluated the factors associated with adverse events in patients with progressive MS.METHODSWe retrospectively analyzed 259 consecutive patients with pure progressive MS with a mitral valve area (MVA) between 1.5 and 2.0 cm2. The primary outcome measures were a composite endpoint of cardiac death, heart failure hospitalization, mitral valve surgery or percutaneous mitral valvuloplasty, and ischemic stroke.RESULTSThe mean patient age was 62 ± 12 years, and the mean MVA was 1.71 ± 0.15 cm2. Over a median follow-up duration of 52 months, a total of 41 patients (18.3%) experienced the composite endpoint. In multivariable Cox regression analysis, prior stroke (hazard ratio [HR], 4.54; 95% confidence interval [CI], 2.16–9.54; p < 0.001) and left atrial volume index (LAVI) of > 50 mL/m2 (HR, 4.45; 95% CI, 1.31–15.31; p = 0.017) were identified as independent predictors of the composite endpoint, even after adjusting for age and sex. Patients with a LAVI ≤ 50 mL/m2 demonstrated favorable event-free survival compared with those with a LAVI > 50 mL/m2 in either the overall population (p < 0.001) or asymptomatic patients (p = 0.002). Atrial fibrillation (AF), left ventricular mass index (LVMI), MVA, and mean diastolic pressure were factors independently associated with LAVI (all p < 0.05).CONCLUSIONSA deleterious impact of a high LAVI on outcome was observed in patients with progressive MS. The LAVI was mainly influenced by the presence of AF, the severity of MS, and LVMI in this population.

Surgical & Interventional Management of Rheumatic Valvular Heart Disease at The Prince Charles Hospital from January 2005–December 2017

Background: The incidence of rheumatic heart disease (RHD) in the indigenous Australian population is the highest in the world. 240 indigenous patients underwent any valve related surgical and interventional procedures at Metro North HHS from January 2005-December 2017. Of these 75 were performed for rheumatic valves at TPCH. Methods: Chart review and electronic database procedural data was analysed, with clinical follow up records, including echocardiography, being collated to identify survival and cardiac status following these interventions. Results: Rheumatic interventions were required over an age range of 10–72 years dominantly female 82%. Percutaneous mitral balloon valvuloplasty was performed in 15 patients, transcatheter aortic valve implantation in 1 patient. Surgical valve repair of 11 isolated mitral valves was achieved. Single valve replacement was done in 10 with multiple valve repair/replacements required in the remaining 38 patients. Mechanical and tissue valves were used almost equally during replacement. Valve failure due to mitral valve thrombus formation, aortic prosthetic patient mismatch, and endocarditis required 8 reoperations. One reoperation following mitral valve repair has been required to date. Pre and post procedure LVEF mean of 56% (range 33–80%) and 57% (range 28–75%) respectively. 30-days hospital survival was 100%, 5 year was 88% and 12 year was 84%. Valve function on follow up with clinical and echo data remains satisfactory. Conclusions: Mitral valve function is durable following valvuloplasty or surgical repair in RHD. Risk to survival during all forms of intervention is low. The type of systemic heart valve utilised for replacement requires close consideration of patient geography, medical access and patient compliance.

Interventional Management of Indigenous Rheumatic Valvular Heart Disease at TPCH

Background: The incidence of rheumatic heart disease (RHD) in the indigenous Australian population is the highest in the world. Review of Queensland Patient Admitted Data Collection and TPCH cardiac clinical databases between January 2005 to December 2017 identified 240 indigenous patients undergoing any valve related interventional procedures at Metro North HHS. Of these 75 were performed for rheumatic valves at TPCH. Methods: Chart review and electronic database procedural data was analysed, with clinical follow up records, including echocardiography, being collated to identify survival and cardiac status following these interventions. Results: Rheumatic interventions were required over an age range of 10–69 years dominantly female 75%. Percutaneous mitral balloon valvuloplasty was performed in 15 patients, transcatheter aortic valve implantation in 1 patient. Surgical valve repair of 11 isolated mitral valves was achieved. Single valve replacement was possible in 10 with multiple valve repair/replacements required in the remaining 38 patients. Mechanical and tissue valves were utilized by 12 surgeons almost equally during replacement. Valve failure due to mitral valve thrombus formation, aortic prosthetic patient mismatch, and endocarditis required 7 reoperations. Hospital 30-day survival was 100%, 5year survival was 90% and 12year survival was 85%, estimated from medical record review. One reoperation following mitral valve repair has been required to date. Valve function on late follow up with clinical and echo data remains satisfactory. Conclusions: Mitral valve function is durable following balloon valvuloplasty or surgical repair in RHD. Risk to survival during all forms of intervention is low. The type of systemic heart valve utilized for replacement requires close consideration of patient geography, medical access and patient compliance.

Measurement of interatrial septal thickness by echocardiography in patients with moderate to severe rheumatic mitral stenosis undergoing percutaneous balloon mitral valvuloplasty

BackgroundLongstanding severe rheumatic mitral stenosis (MS) is associated with changes in the atrial chamber dimensions. It is not known whether there is an increased thickness of the inter-atrial septum (IAS) in patients with severe rheumatic mitral stenosis. The objective of this study was to evaluate pre-procedural IAS thickness by echocardiography in patients with moderate to severe rheumatic mitral stenosis undergoing percutaneous balloon mitral valvuloplasty (PBMV). MethodsThe thickness of the IAS was measured by transesophageal echocardiography (TEE) in 86 patients between 14 and 65 years of age. Patients with moderate to severe rheumatic mitral stenosis undergoing percutaneous mitral balloon valvuloplasty (PMBV) at the National Institute of Cardiovascular Diseases (NICVD), Karachi were recruited for this study. IAS thickness was measured by TEE using standard views and 3 different phases of cardiac cycles were evaluated. ResultsOut of 86 patients, almost three fourths (73.3%) were between 14 and 29 years of age and two thirds (62.8%) were females. Mean IAS thickness was 2.56 (SD 0.92) mm at anterior region (AR), 1.89 (SD 0.75) mm at fossa ovalis (FO), and 2.95 (SD 0.97) mm at posterior region (PR). None of the demographic and clinical groups showed any statistically significant difference in IAS thickness. ConclusionsInter-atrial septum (IAS) thickness measurement does not change in the presence of moderate to severe rheumatic mitral stenosis as compared to the reported normal values of IAS thickness in cadaveric hearts.

Immediate Results of Percutaneous Mitral Balloon Valvuloplasty in Patients with Mitral Stenosis

Introduction: Mitral stenosis is a prevalent valvular disease in developing countries. Percutaneous mitral balloon valvuloplasty (PMBV) is the gold standard treatment. The main objective of this study was to assess the initial results of PMBV in patients with mitral stenosis during 16 years (2002-2018) in Mashhad, Iran. Materials and Methods: From April 2002 to March 2018, 770 patients underwent PMV in department of cardiology. PMV was performed by the antegrade transseptal method using the Inoue balloon. Results: The obtained success rate was 97%. In this study, the valve area increased from 0.9±1.1 to 1.8±0.2 cm2 (P<0.0001). There was no case of peri-procedural death or cardiac tamponade. Additionally, 0.25% of the patients required mitral valve replacement. Severe mitral regurgitation occurred in 0.9% of the subjects. There was no case of cerebrovascular accident, transient ischemic attack, embolic myocardial infarction, or cardiac perforation. Supraventricular tachycardia occurred in 2.59% of the patients. Conclusion: The PMBV by the Inoue technique is a feasible and easy procedure with a short crossing times and low complications.

Right ventricular strain and strain rate and pulmonary function before and after percutaneous baloon mitral valvuloplasty in patients with severe rheumatic mitral stenosis

Right ventricular strain and strain rate and pulmonary function before and after percutaneous baloon mitral valvuloplasty in patients with severe rheumatic mitral stenosis

PO623 Echocardiographic Score Influence, Survival and Event-Free Survival In Long-Term Follow-Up of Percutaneous Mitral Balloon Valvuloplasty

PO623 Echocardiographic Score Influence, Survival and Event-Free Survival In Long-Term Follow-Up of Percutaneous Mitral Balloon Valvuloplasty

PO628 Inoue Balloon Versus Single Balt Balloon Technique In Percutaneous Mitral Balloon Valvuloplasty. Results, In-Hospital Evolution and Cost

In-stent restenosis (ISR) remains a problematic issue of coronary intervention. The non-slip element balloon (NSE) is a balloon catheter with 3 longitudinal nylon elements which are attached proximally and distally to the balloon component. The expectation is that this design of balloon is able to achieve a larger lumen area due to the elements, as well as reducing balloon slippage. We investigated whether NSE pre-dilatation improves angiographic outcomes compared to a high pressure non-compliant balloon pre-dilatation, followed by a drug-coating balloon (DCB) for treatment of ISR lesions with optical coherence tomographic imaging (OCT).Patients were eligible for the study if one or more in-stent restenosis lesions were treated with a paclitaxel-coating balloon. Patients were randomized to NSE pre-dilatation (NSE group) or high pressure non-compliant balloon pre-dilatation (POBA group) in a 1:1 fashion in 17 hospitals. The primary endpoint was in-segment late loss [post minimal lumen diameter (MLD) − follow-up MLD] at 8 months.One hundred and five patients were allocated to each group. Balloon slippage (7.9% versus 22.9%, p = 0.002) and geographical miss (6.9% versus 21.9%, p = 0.002) were observed less in the NSE group compared to the POBA group. Acute gain was significantly larger in the NSE group (1.17 ± 0.42 mm versus 1.06 ± 0.35 mm, p = 0.04), but post minimum stent lumen area analyzed by OCT was similar between the two groups (3.85 ± 1.67 mm2 versus 3.81 ± 1.93 mm2, p = 0.64). At 8 months, average lesion length was significantly shorter than the POBA group (5.78 ± 3.26 mm versus 6.97 ± 4.59 mm, p = 0.04), but average in-segment late loss was similar between the two groups (0.28 ± 0.45 mm versus 0.27 ± 0.38 mm, p = 0.75).Eight-month angiographic outcomes were similar between NSE and non-compliant balloon pre-dilatation with DCB for treatment of ISR lesions. However, NSE pre-dilatation has advantages such as reduction of balloon slippage and geographical miss during the procedure.

Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty.

Conventional hemodynamic parameters may not accurately predict symptomatic improvement after percutaneous mitral valvuloplasty (PMV). Changes in left heart chamber compliance following adequate relief o0066 mitral stenosis (MS) may be useful in determining functional capacity after PMV. This study aims to determine the acute effects of PMV on compliance of the left heart and whether its changes relate to the patient's functional capacity. One-hundred thirty-seven patients with severe MS undergoing PMV were enrolled. Left atrial (Ca ) and left ventricular (Cv ) compliance were invasively estimated and net atrioventricular compliance (Cav ) was calculated before and immediately after the procedure. B-type natriuretic peptide (BNP) levels were obtained before and 24 hr after the procedure. The primary endpoint was functional status at 6-month follow-up, and the secondary endpoint was a composite of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, or stroke in patients in whom PMV was successful. The mean age was 43 ± 12 years, and 119 patients were female (87%). After PMV, Ca and Cav improved significantly from 5.3 [IQR 3.2-8.2] mL/mmHg to 8.7 [5.3-19.2] mL/mmHg (P < 0.001) and 2.2 [1.6-3.4] to 2.8 [2.1-4.1] mL/mmHg (P < 0.001), respectively, whereas Cv did not change (4.6 [3.2-6.8] to 4.4 [3.1-5.6]; P = 0.637). Plasma BNP levels significantly decreased after PMV, with no correlation between its variation and changes in left chamber compliance. At 6-month follow-up, NYHA functional class remained unchanged in 32 patients (23%). By multivariable analyses, changes in Ca immediately after PMV (adjusted OR 1.42; 95% CI 95% 1.02 to 1.97; P = 0.037) and younger age (adjusted OR 0.95; CI 95% 0.92-0.98; P = 0.004), predicted improvement in functional capacity at 6-month follow-up, independent of postprocedural data. The secondary endpoint were predicted by post-PMV mean gradient (adjusted HR 1.363; 95% CI 95% 1.027-1.809; P = 0.032), and lack of functional improvement at 6-month follow-up (adjusted HR 4.959; 95% 1.708-14.403; P = 0.003). Ca and Cav increase significantly after PMV with no change in Cv . The improvement of Ca is an important predictor of functional status at 6-month follow up, independently of other hemodynamic data. Postprocedural mean gradient and lack of short-term symptomatic improvement were predictors of adverse outcome.

TCT-801 Predictors of Immediate Success and Long-Term Clinical Outcomes After Percutaneous Mitral Balloon Valvuloplasty in Patients With Rheumatic Mitral Stenosis

Percutaneous mitral balloon valvuloplasty (PMBV) still remains as the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis and suitable anatomy. This study sought to access the immediate and very long-term outcomes after successful PMBV. This is a single-center

P2580Predictors factors for survival and event free survival in long-term follow-up after percutaneous mitral valvuloplasty with Inoue versus single balloon tecnique

P2580Predictors factors for survival and event free survival in long-term follow-up after percutaneous mitral valvuloplasty with Inoue versus single balloon tecnique

P2576Immediate results and long-term follow-up of percutaneous mitral valvuloplasty in patients with pulmonary hypertension

P2576Immediate results and long-term follow-up of percutaneous mitral valvuloplasty in patients with pulmonary hypertension

Percutaneous mitral valvuloplasty in the modern era.

Percutaneous mitral valvuloplasty in the modern era.

ANESTHETIC MANAGEMENT OF PREGNANT PATIENT WITH VALVULAR HEART DISEASE

Gebelikle birlikte kan hacmi, kalp debisi, kalp hızı artarken sistemik vasküler direnç azalır. Hemodilüsyon ve fizyolojik anemi görülür. Bu değişiklikler sağlıklı kadınlar tarafından tolere edilebilirken kalp hastalığı olan gebelerde kalp üzerinde ayrı bir yük oluşturmaktadır. Bunun sonucunda peripartum morbidite ve mortalite artmaktadır. Bu hastaların anestezi seçimi kalp hastalığının tipi, kullanılan ilaçlar, cerrahinin aciliyetine göre değişmektedir. 32 yaşında olan hastamızın 4 gebelik, 2 doğum ve 2 abortusu mevcuttu. Hastamıza 39 haftalık gebeliği ne-deniyle sezeryan planlanmıştı. Preoperatif mu-ayenesinde 5 yıl önce perkütan mitral balon valvüloplasti geçirdiği öğrenildi. Ekokardiyog-rafide mitral kapak alanı 1 cm2 olduğu, 30 aort yetmezliği ve pulmoner arter basıncı 35 mm Hg olarak tespit edildi. Hastaya lomber 4-5 verteb-ra aralığından oturur pozisyonda kombine spi-nal–epidural anestezi yapıldı. Epidural katater yoluyla perioperatif ve postoperatif anestezi ve analjezi sağlandı. Sonuç olarak kalp hastalığı olan gebelerde sezaryen uygulamasında düşük doz kombine spinal-epidural anestezi ile hemo-dinaminin daha stabil olacağını ve epidural ka-tater yoluyla da postoperatif analjezi sağlanarak taşikardi, hipertansiyon, ajitasyon gibi olumsuz etkilerin önleneceğini düşünüyoruz.

Different Characteristics, Clinical Outcomes, and Left Atrial Reverse Remodeling in Patients with Mitral Stenosis Maintaining Sinus Rhythm for at Least 10 Years after Successful Percutaneous Mitral Valvuloplasty

Background: We aimed to investigate the characteristics and echocardiographic changes in patients with severe mitral stenosis (MS) who maintained sinus rhythm (SR) for at least 10 years after successful percutaneous mitral balloon valvuloplasty (PMV). Methods: We retrospectively reviewed 107 patients who had successful PMV and follow-up echocardiography for at least 10 years without mitral valve surgery. Preprocedural, immediate postprocedural (PMV), and long-term follow-up echocardiography (at least 10 years after PMV) data were reviewed. Results: The mean follow-up time after PMV was 15 ± 4 years for SR patients (n = 50) and 16 ± 4 years (p = 0.172) for atrial fibrillation (AF) patients (n = 57). The left atrial diameter was significantly decreased in SR patients in the follow-up echocardiography images compared to its pre-PMV value (46.7 ± 6.3 vs. 43.3 ± 6.2 mm, respectively), whereas it was significantly increased in patients with AF (53.9 ± 7.1 vs. 58.1 ± 8.7 mm). In multivariate analysis, preprocedural AF (odds ratio [OR] 14.50, p = 0.001) and LA diameter ≥50 mm (OR 8.81, p < 0.001) were independently associated with increased risk for the presence of AF after successful PMV. Conclusion: Very long-term maintenance of SR after successful PMV was associated with preprocedural SR and LA diameter < 50 mm.

OP-352 - Non-Surgical Method of Managing Iatrogenic Aortic Perforation with Amplatzer Vsd Occluder during Percutaneous Mitral Balloon Valvuloplasty

Within all cardiac chambers the hardest one to reach percutaneously is the left atrium. The transseptal puncture is a direct route to the left atrium and a routine procedure to access the left atrium including mitral balloon valvuloplasty, paravalvuler leak closure, hemodynamic assessment and catheter ablation.

CRT-700.48 Prior Surgical Mitral Commissurotomy And Echocardiographic Score Influence in Mitral Balloon Valvuloplasty. Immediate Post-Procedure Results

Percutaneous mitral balloon valvuloplasty is effective in mitral stenosis. To evaluate prior mitral surgical commissurotomy (PMC) and echocardiographic score (ES) in the results and complications of mitral balloon valvuloplasty (MBV). From 1987 to 2013, 526 procedures were performed with Inoue