Results Of Balloon Mitral Valvuloplasty Research Articles

Balloon mitral valvuloplasty in low gradient severe rheumatic mitral stenosis: Immediate and short-term outcomes

BackgroundEfficacy of balloon mitral valvuloplasty (BMV) in low gradient severe rheumatic mitral stenosis (MS) is not very well defined. This study was undertaken to evaluate the outcomes of BMV in low gradient severe rheumatic MS. MethodsSevere MS was defined as mitral valve area < 1.5 cm2. Low gradient was defined as mean diastolic trans-mitral gradient (MG) < 10 mmHg and low flow as stroke volume index < 35 ml/m2 on echocardiography. Sixty patients were divided into normal-flow/low-gradient (NFLG) (40) and low-flow/low-gradient (LFLG) (20) groups. Post-BMV parameters were recorded after 72 h and at the end of one year. ResultsMean age was 36.2 ± 6.6 years in NFLG group and 40.6 ± 2.6 years in LFLG group (p < 0.01) and females were 75 % (n = 30) in NFLG group as compared to 60 % (n = 12) in LFLG group. Patients in the LFLG group had higher Wilkins score (p < 0.02) and prevalence of atrial fibrillation (n = 8, 40 %) as compared to NFLG group (n = 7, 17.5 %; p < 0.01). A greater decrease in MG was observed in NFLG group (p < 0.01), whereas increase in MVA was comparable in both the groups (p > 0.05). Ninety percent (n = 36) patients improved in NFLG group in comparison to 70 % (n = 14) in LFLG group (p < 0.01). At the end of one-year, symptomatic improvement persisted in all patients who became asymptomatic post-BMV. ConclusionSymptomatic improvement following BMV was better seen in NFLG group because of greater decrease in MG in comparison to LFLG group. Results of BMV were suboptimal in LFLG group because of higher sub-valvular obstruction, increased age and higher prevalence of AF.

Clinical outcomes of percutaneous balloon valvuloplasty in patients with critical mitral stenosis

Background: Clinical outcomes after percutaneous balloon valvuloplasty in patients with critical mitral stenosis is challenging and widely discussed. Aim of the study was to analyze the results of balloon mitral valvuloplasty (BMV) using the Inoue technique in patients with critical mitral valve stenosis. Material and Methods: From January 2020 to 2022, balloon mitral valvuloplasty was performed in 31 patients with critical mitral valve stenosis using the Inoue technique. There were 14 men (45.2%), women - 17 (54.8%). The patients were aged from 19 to 59 years, on average 42.4±6.1 years. All patients data were analyzed to evaluate the possible outcomes. Results: In 30 (96.4%) patients, a successful BMV was performed. In 1 (3.2%) patients, PMV failed, including puncture was unsuccessful, and it was not possible to pass a balloon catheter from the LA to the LV through the critically narrowed mitral valve opening. These failures took place at the initial stages of mastering the technique. A lethal outcome was noted in 0 (0.0%) case. In all 30 (96.8%) patients after BMV, positive results were obtained: the area of the mitral orifice increased by an average of 2.5 times, from 0.85±0.17 to 2.16±0.76 cm2 (p&lt; 0.001), the maximum gradient at the level of the mitral valve decreased by 60.5%, on average from 26.9±2.95 to 8.9±0.6 mm Hg. (p&lt;0.0001). The maximum pressure in the LA statistically significantly decreased from 40.29±6.01 mm Hg. Art. up to 21.43±3.83 mm Hg (p&lt;0.05), in LA - from 49.7±10.9 to 29.7±8.2 mm Hg. (p&lt;0.05). According to EchoCG data, regurgitation on the mitral valve after BMV appeared in 6 (24.1%) patients up to I degree, in 1 (3.2%) - up to II, and in 1 (3.2%) - up to III. In 16 (61.5%) of 26 patients with initial mitral insufficiency after BMV, the degree of regurgitation remained at the same level, in 8 (30.7%) the latter increased to II, in 2 (7.7%) - to III degree. Conclusion: BMV using the INOUE technique is a highly effective minimally invasive treatment method, accompanied by a low morbidity and mortality rate.

Impact of 3D transesophageal echocardiography assessment of mitral valve on short-term outcome of Balloon Mitral Valvuloplasty using additional quantitative parameters

The goals of this prospective observational study were to identify quantitative morphological factors that might aid in the prediction of PBMV outcome, as well as to define the function of 3D TEE in mitral valve evaluation. Material and Methods: The trial comprised seventy individuals who had isolated severe rheumatic Mitral Stenosis (MS) who were scheduled for PBMV between October 2017 and March 2021. Trans-thoracic echocardiography (TTE) was used for pre-procedural evaluation. Posterior to Anterior Leaflet Length Ratio (P/ALLR), Commissural Area Ratio (CAR), Doming Height (DH), and Calcification Score (Ca score) were also assessed using 2D and 3D-Trans-esophageal Echocardiography (TEE). Following that, all patients were monitored for three months. Results: We have had 50(71.5%) successful procedures and 20(28.5%) unsuccessful procedures. The additional parameters showed highly significant difference between successful and un-successful groups (P-value &lt;0.001). The cut-off points that predict successful procedures were; P/A LLR &gt;0.6 and &gt;0.55 by 2-D and 3-D TEE respectively, CAR ≤ 1.28 and ≤ 1.25 by 2-D and 3-D TEE respectively, DH &gt; 1.2 cm by 2-D TEE, and Ca Score ≤ 2. Conclusion: In our research, we discovered that these characteristics may predict the result of PBMV and contribute value to the semi-quantitative methodologies we adopted to use.

Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy.

Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres. To assess the immediate post procedure outcome of over the wire BMV with JOMIVA balloon. Clinical and echocardiographic parameters of pregnant women with significant mitral stenosis who underwent elective BMV with JOMIVA balloon in our institute from 2005 to 2015 were analysed retrospectively. Severity of breathlessness (New York Heart Association Functional Class), and duration of pregnancy was included in the analysis. Pre procedural echocardiographic parameters which included severity of mitral stenosis and Wilkin's scoring were analysed. Clinical, haemodynamic and echocardiographic outcomes immediately after the procedure were analysed. Among the patients who underwent BMV in our Institute 38 were pregnant women. Twenty four patients (63%) were in New York Heart Association (NYHA) Class III. All of them were in sinus rhythm except two (5%) who had atrial fibrillation. Thirty four patients (89.5%) were in second trimester of pregnancy at the time of presentation and four (10.5%) were in third trimester. Echocardiographic analysis of the mitral valve showed that the mean Wilkin's score was 7.3. Mean mitral valve area pre procedure was 0.8 cm2. Mean gradient across the valve was 18 mmHg. Ten patients (26.5%) had mild mitral regurgitation and none had more than mild mitral regurgitation. Thirty six patients had pulmonary hypertension as assessed by tricuspid regurgitation jet velocity. All of them underwent BMV with JOMIVA balloon. Post procedure mean mitral valve area was 1.7 cm2 as assessed by echocardiography. Post procedure mean gradient across the mitral valve as assessed by echocardiography was 5 mmHg. Two patients had moderate to severe mitral regurgitation after the procedure and the rest had either no mitral regurgitation or mild mitral regurgitation after the procedure. None of the patients warranted mitral valve replacement after BMV. No patients had any manifestations of systemic embolism like cerebrovascular accident or limb ischemia after the procedure. None of the patients had preterm delivery or adverse fetal outcome during index hospitalisation. Over the wire BMV is safe and effective method during pregnancy. The results are comparable to that of Inoue technique. BMV offers a good symptomatic improvement in pregnant women presenting with symptoms of pulmonary congestion because of Rheumatic mitral stenosis.

TCT-813 Immediate and 18-Month Outcome of Balloon Mitral Valvuloplasty: Comparison of Inoue and Multi-Track System

TCT-813 Immediate and 18-Month Outcome of Balloon Mitral Valvuloplasty: Comparison of Inoue and Multi-Track System

Immediate and 18‐Month Outcome of Balloon Mitral Valvuloplasty: Comparison of Inoue and Multi‐Track System

Aims: To compare the immediate and 18‐month clinical and echocardiographic outcome of Inoue and multi‐track system for balloon mitral valvuloplasty (BMV). Methods: We included 78 consecutive patients with moderate to severe rheumatic mitral stenosis (MS) [mitral valve area (MVA) &lt; 1.5 cm2] and clinically indicated BMV. The first 42 consecutive patients were assigned to Inoue BMV (group I), and the following 36 consecutive patients were assigned to multi‐track system (group M). Clinical and echocardiographic assessment was performed before, immediately after, 3 months after, and 18 months after the procedure. Results: The successful immediate result [MVA &gt; 1.5 cm2 and mitral regurgitation (MR) &lt; II/IV] was achieved in 40 (95.23%) patients of group I and 34 (94.44%) patients of group M (P = 0.12). Immediately after BMV, MVA increased from 0.9 ± 0.4 to 1.7 ± 0.5 cm2 in group I and from 0.8 ± 0.2 to 1.9 ± 0.3 cm2 in group M (P &lt; 0.01). Bilateral commissural splitting was significantly higher in group M (P &lt; 0.01). This was associated with higher incidence of mild commissural mitral regurgitation. There were no significant differences of moderate to severe MR. Both procedure and fluoroscopy time were significantly shorter in group I (P &lt; 0.001). Eighteen‐month clinical and echocardiographic evaluation was available for 66 (84.64%) patients with sustained immediate clinical and echocardiographic improvements. Conclusions: Both Inoue and the multi‐track balloon systems achieved successful immediate and 18‐month results. The multi‐track double balloon system produced significantly larger MVA, with better bilateral commissurotomy, yet with longer procedure and fluoroscopy times. (J Interven Cardiol 2012;25:47–52)

Utility of the Posterior to Anterior Mitral Valve Leaflets Length Ratio in Prediction of Outcome of Percutaneous Balloon Mitral Valvuloplasty

Scoring of mitral stenosis (MS) severity is very important for selection of patients for balloon mitral valvuloplasty (BMV). We propose a novel yet simple, independent parameter of MS severity based on the posterior mitral valve leaflet to anterior mitral valve leaflet length ratio (PMVL/AMVL length ratio). It could be a useful predictor to outcome of BMV. A total of 106 patients (mean age 29.1 ± 8.6 years) had MS with mitral valve score of eight or less. The length of anterior mitral valve leaflet and posterior mitral valve leaflet were measured. Patients were classified into group with ratio ≥1/2 and group of ratio <1/2. Eighty-five healthy control subjects were studied. Patients with PMVL/AMVL ratio ≥1/2 post-BMV had lower transmitral gradients (4.5 ± 3.1 mmHg vs. 9.7 ± 2.1 mmHg, P < 0.002) and greater mitral valve area (MVA) (2.09 ± 0.3 cm(2) vs. 1.5 ± 0.2 cm(2) , P < 0.001), lower pulmonary artery systolic pressure (PASP) (23.8 ± 14.3 mmHg vs. 34.2 ± 12.5 mmHg, P < 0.001), left atrial pressure (10.2 ± 6.7 mmHg vs. 18.9 ± 6.4 mmHg, P < 0.001), and lower incidence of de novo or worsening of mild mitral regurgitation (MR; 1.64% vs. 8.9%, 0% vs. 6.6%, P < 0.001). PMVL/AMVL length ratio was positively correlated with post-BMV MVA (r = 0.69, P < 0.002), PASP (r = 0.592, P < 0.003), and negatively correlated with incidence of de novo or worsening of mild MR (r =-0.78, -0.93, P < 0.001). The regression analyses revealed that PMVL/AMVL ratio is the best and a reliable predictor of success and outcome of BMV, hazard ratio (95% confidence interval) 0.12 (0.05-52), P < 0.001. Length ratio of PMVL/AMVL assessment with echocardiography is an excellent simple predictor of post-BMV mitral valve area and the cardiac events.

Long-Term Clinical Outcome Of Balloon Mitral Valvuloplasty. What Is The Predictor?

Penyakit Katup Jantung khususnya Penyakit Mitral Stenosis masih merupakan masalah yang harus ditanggulangi di negara berkembang termasuk Indonesia. Katup Mitral yang mengalami stenosis dan umumnya disebabkan oleh Penyakit Rheuma akan mengalami perburukan klinis dan hemodinamik sebanding dengan makin mngecilnya orificium Katup Mitral. Secara hemodinamik tekanan atrium kiri akan meningkat , demikian selanjutnya tekanan Vena Pulmonalis Kanan (RVP-Right Pulmonary Vein ) meningkat . 1,2. RVP diketahui merupakan faktor yang berperan dalam perjalanan natural penyakit SM dan dapat memengaruhi prognosis pasca tindakan intervensi baik pembedahan maupun intervensi non bedah dan bila terus meningkat maka gagal jantung kanan akan timbul. Penurunan luas katup, menjadi < 2,5 cm2, akan menyebabkan terjadinya peningkatan gradien tekanan. Gejala SM baru muncul ketika MVA telah mencapai 1,5 cm2 atau kurang. 3,4 Upaya yang dilakukan secara rational menurunkan tekanan dengan melebarkan diameter orificium katup Mitral melalui Baloon Mitral Valvuloplasty (BMP) atau komisurotomi katup Mitral per Kutan (KTMP) . Masalah yang dihadapi apakah dapat diprediksi berapa besar katup Mitral yang harus dilebarkan ? Apakah pelebaran katup Mitral sampai ukuran tertentu menjamin perbaikan klinis maupun hemodinak ? Apakah pemeriksaan Non Invasif (Ekokardiografi ) dapat dipakai sebagai pemeriksaan standar tanpa melibatkan hasil katerisasi ?

Long-Term Clinical Outcome Of Balloon Mitral Valvuloplasty Based On Echocardiographic And Catheterization Criteria

Background. Balloon Mitral Valvuloplasty (BMV) can provides effectively the mechanical obstruction relief in mitral stenosis. Achieving a successful BMV based on echocardiographic criteria potentially increase mitral regurgitation complication. In addition, long-term clinical outcome of a successful BMV based on catheterization criteria has not been widely elaborated. This study aims to compare the long-term clinical outcome of BMV based on the echocardiographic criteria and the catheterization criteria. Methods. A cross sectional study was conducted in mitral stenosis patients after BMV procedure. Patients was divided into 2 groups based on successful echocardiographic criteria (MVA ≥ 1,5 cm2 vs MVA < 1,5 cm2). The long-term clinical outcome was evaluated using 6 minute walk test and SF-36 questionnaire. Results. Twenty two female patients were fulfilling study criteria with aged 38,8 ±12,0 years and 63,6% in atrial fibrillation. The characteristic between two groups were not significantly different. Six minute walk test results was not significantly different between two groups (6,6 ±0,8 vs 7,3±1,0 p = 0,103). SF-36 physical components summary was not significantly different between two groups (43,0±7,5% vs 42,1±6,7 p = 0,770). Also, SF-36 mental components summary was not significantly different between two groups (50,7±5,9 vs 53,9±8,9 p = 0,338). Conclusion. There was no significantly different of long-term clinical outcome between the echocardiographic criteria of successful BMV and the catheterization criteria of successful BMV. (J Kardiol Indones. 2010; 31:28-38.) Keywords: mitral stenosis, Balloon Mitral Valvuloplasty, 6 minute walk test, SF-36

Percutaneous mitral balloon valvuloplasty in patients with previous surgical mitral commissurotomy

This prospective observational study was done in National Institute of Cardiovascular Diseases and hospital Dhaka, during the period April 2002 to July 2008. In this study the immediate results of balloon mitral valvuloplasty with mitral restenosis patients with previous surgical mitral commissurotomy was evaluated. We have done 50 cases of percutaneous balloon mitral valvuloplasty in patients who had the history of previous surgical commissurotomy. Out of these 50 patients 8 patients were male and 42 patients were female. The age range was 25-55 years with duration of surgical commissurotomy (SC) of 2-18 years past. The result of balloon mitral valvuloplasty (BMV) was successful in 48 cases and failed in 2 cases due to huge left atrium, balloon did not negotiate from LA to LV. Mitral valve area (MVA) before the procedure was 0.5-0.9 sq cm with mean 0.7± 2 sq cm. Following procedure the MVA was 1.6-2.04 cm2 with a mean of 1.8±0.2 cm2. Gradient across mitral valve (MV) before and after the procedure was 20-44 mm Hg with a mean of 32±-12 mm Hg and 8-12 mmHg with a mean of 10±2 mm Hg. MVA &gt;1.8 cm2 was achieved in 41 cases &amp;1.8-1.6 cm2 in 7 cases. Mitral regurgitation &gt;1 grade occurred in 8 cases. So we conclude that BMV in patients with mitral restenosis following SC can be performed successfully with low risk of major cardiac complications. Key words: Surgical commissurotomy (SC), balloon mitral valvuloplasty (BMV) doi: 10.3329/uhj.v5i1.3433 University Heart Journal Vol. 5, No. 1, January 2009 9-12

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

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

Preliminary results of balloon mitral valvuloplasty with inoue balloon: A Sri Lankan experience

Preliminary results of balloon mitral valvuloplasty with inoue balloon: A Sri Lankan experience

The value of transesophageal echocardiography in predicting immediate and long-term outcome of balloon mitral valvuloplasty: comparison with transthoracic echocardiography.

The purpose of this study was to assess the role of transesophageal echocardiography in predicting the immediate and long-term outcome of balloon mitral valvuloplasty, and compare the results to transthoracic echocardiography. Transesophageal echocardiography accurately detects left atrial thrombi and allows better visualization of mitral valve morphology; however, its value in predicting the immediate and long-term outcome of balloon mitral valvuloplasty had not been assessed as adequately as for transthoracic echocardiography. In 56 patients referred for balloon mitral valvuloplasty, both transesophageal and transthoracic echocardiography were performed (Group A). An echo score for both techniques was used to reflect mitral valve morphology, and its predictive value for immediate and long-term outcome of the valvuloplasty was assessed. The impact of transesophageal echocardiography in preventing procedural embolic events in those 56 patients was assessed by comparison to another group of 41 patients, who were examined only by transthoracic echocardiography prior to balloon mitral valvuloplasty (Group B). In Group A, transesophageal echocardiography detected left atrial thrombus in seven, while transthoracic echocardiography detected left atrial thrombus in two patients. After 2 months of warfarin therapy, a repeat transesophageal echo examination in four patients showed resolution of thrombus in three who went on to have balloon mitral valvuloplasty. Among the 52 patients who eventually had the procedure after thrombus was excluded by transesophageal echocardiography, there were no embolic events, compared to three embolic events among the 41 patients in Group B (P = 0.08). The transthoracic echocardiography scores, while slightly higher, correlated well with transesophageal echocardiography scores (r = 0.51, P < 0.001). The increase in mitral valve area did not correlate well to total transthoracic or transesophageal echocardiography scores, while it correlated negatively to valve calcification by transthoracic (r = -0.29, P < 0.05) and mobility by transesophageal echocardiography (r = -0.59, P < 0.02). At follow-up (7 +/- 4 months) nonsurvivors (7/56) had higher total scores by either transthoracic (P < 0.01) or transesophageal echocardiography (P < 0.05) compared to survivors. The percent reduction in mitral valve area was greater with age (r = 0.5, P < 0.02), time to follow-up (r = 0.67, P < 0.002), valve mobility by transthoracic echocardiography (r = 0.59, P < 0.01), and valve calcification by transthoracic echocardiography (r = 0.37, P = 0.09) and transesophageal echocardiography (r = 0.4, P = 0.07). Transesophageal echocardiography is superior to transthoracic echocardiography in detecting left atrial thrombi, and it may reduce the risk of embolic events following balloon mitral valvuloplasty. Assessment of mitral valve morphology by transesophageal echocardiography is complementary and not superior to assessment by transthoracic echocardiography. Mitral valve calcification and mobility appear to be the best morphological predictors of immediate and long-term outcome following balloon mitral valvuloplasty.

Percutaneous balloon mitral valvuloplasty: Analysis of echocardiographic and other variables related to outcome

To determine whether mitral valve (MV) morphology influences the result of balloon mitral valvuloplasty (BMV) for mitral stenosis, two-dimensional echocardiography was performed before BMV in 53 patients and in 25 normal controls. The two-dimensional echocardiographic features of MV leaflets: thickness, length and motion, diastolic MV excursion, chordal length, MV annular diameter (MVAnD), subvalvular distance ratio (SDR), and effective balloon dilating area (EBDA) and diameter (EBDD) were then correlated to the immediate post-BMV mitral valve area (MVA). For the total patient population, post-BMV MVA increased from 0.76 ± 0.24 to 1.91 ± 0.59 cm 2 ( p < 0.0001) and mean diastolic transmitral gradient decreased from 20.1 ± 6.15 to 5.8 ± 3.29 mm ( p < 0.0001). The patients were divided into two groups on the basis of post-BMV MVA. Group I had post-BMV MVA <2.0 cm 2 and group II had post-BMV MVA ≥2.0 cm 2. A statistically significant difference was noted in SDR (0.33 ± 0.057 vs 0.45 ± 0.042, p < 0.0001); mid-MV anulus to tip of papillary muscle (PM) distance (20.0 ± 3.8 vs 27.9 ± 4.54 mm, p < 0.0001); chordal length (4.3 ± 3.6 vs 9.8 ± 3.9 mm, p < 0.0001); diastolic MV excursion (15.5 ± 2.6 vs 18.2 ± 4.2 mm, p < 0.01); leaflet mobility ( p < 0.05); and EBDA (4.4 ± 0.6 vs 4.9 ± 0.5 cm 2, p < 0.01). On discriminant function analysis of all the echocardiographic variables, the SDR had the strongest discriminating power, followed by mid-MV anulus to tip of PM distance, EBDD MVAnD , and EBDA/body surface area (BSA), and had an accuracy of 90.6% for correctly differentiating two groups. We conclude that quantitative assessment of SDR, mid-MV anulus to tip of PM distance, EBDD MVAnD by two-dimensional echocardiography, and EBDA BSA are helpful in predicting the immediate outcome of BMV.

Usefulness of echocardiography in the prediction of early results of catheter balloon mitral valvuloplasty.

Catheter balloon mitral valvuloplasty (BMV) was performed in 50 patients and 32 of them undergoing BMV with double balloon technique were studied to evaluate the usefulness of echocardiography in the prediction of early results of BMV. Five echocardiographic variables including mitral valve motion, mitral valve thickness, subvalvular change, commissural calcification and left atrial dimension were evaluated. Each variable was divided into mild, moderate and severe subgroups. Before valvuloplasty there were no differences in mitral valve area among any subgroup for any variable. After valvuloplasty, variables associated with a greater increase in mitral valve area from mild and moderate subgroups than from severe subgroup included mitral valve motion, mitral valve thickness, and subvalvular change, but not commissural calcification or left atrial dimension. We scored the former 3 variables as 0, 1 and 2 points in the mild, moderate and severe subgroups, respectively. The sums of individual scores in these 3 variables were further divided into 3 groups: 12 patients had a lower score (less than 2), 10 patients had a score of 3-4 and 10 patients had a higher score (greater than 5). Patients with lower scores tended to have greater increases in mitral valve areas after valvuloplasty than those with higher scores. Thus, mitral valve motion, mitral valve thickness and subvalvular change may be useful to predict a greater increase in mitral valve area after valvuloplasty. A lower score of echocardiographic variables anticipates successful balloon mitral valvuloplasty, which may be helpful in patient selection.