Successful Percutaneous Balloon Mitral Valvuloplasty Research Articles

TCT-628 Very Long-Term (Up To 23 Years) Follow-Up After Successful Mitral Balloon Valvuloplasty In A Large Series Of Patients With Rheumatic Mitral Stenosis

Introduction: Although there has been a steady decline in the incidence of rheumatic heart disease, rheumatic mitral stenosis still causes significant morbi-mortality worldwide. Percutaneous mitral balloon valvuloplasty (PMBV) remains as the preferred treatment option for patients with suitable anatomy and severe symptomatic rheumatic mitral stenosis. Hypothesis: We sought to assess the very long-term outcomes after successful PMBV. Methods: This is a single center analysis of all consecutive patients who underwent successful PBMV (post-procedural valve area ≥ 1.5 cm 2 and regurgitation moderate or less, without in-hospital major adverse cardiac and cerebrovascular events) between 1988 and 2011. The primary endpoint was to determine the incidence of major adverse cardiac events (MACE), including global death and need for mitral surgery or repeat PMBV up to 23 year after the procedure. Results: Among all 1577 patients, the success rate was achieved in 91.3% (1140 patients). The predictors of success were NYHA functional class III-IV (hazard ratio [HR]: 1.73, 95% CI: 1.15-2.60, p=0.008) and Wilkins-score Conclusions: Up to 23 years after successful PMBV, a sizeable proportion of patients still exhibit sustained results after PMBV.

Usefulness of the Macruz Index for Predicting Successful Percutaneous Mitral Balloon Valvuloplasty in Patients with Mitral Stenosis

Objective: The aim of this study was to determine whether the Macruz index (P/P-R segment) could predict the severity of valvular involvement and the success of percutaneous mitral balloon valvuloplasty (PMBV) in patients with mitral stenosis (MS). Subjects and Methods: Sixty-one patients with MS eligible for PMBV and 72 healthy subjects (61 females and 11 males) with sinus rhythm were enrolled into this study. PMBV was performed in all patients using a percutaneous transseptal antegrade approach and a multitrack balloon technique. The P/P-R segment ratio and echocardiographic variables were measured before and 48-72 h after the procedure. The optimal cutoff point for differences in the Macruz index to determine clinical success was evaluated by receiver operating characteristic analysis by calculating the area under the curve as giving the maximum sum of sensitivity and specificity for the significant test. Results: In the patient group (mean age 42.9 ± 11.1 years), the preprocedural Macruz index was significantly higher than in the control group (2.79 ± 1.03 vs. 1.29 ± 0.11; p < 0.001). In the successful-procedure group (n = 53), the mean postindex value was significantly lower (2.12 ± 0.71 vs. 2.81 ± 1.0, p = 0.020), and the decrease in the Macruz index was significantly higher than in the unsuccessful-procedure group (p = 0.007). An index decrease of 0.105 was the best cutoff value to distinguish the successful-PMBV group from the unsuccessful- PMBV group (area under the curve = 0.888, 95% confidence interval 0.788-0.988, p < 0.001). Conclusion: The Macruz index was significantly higher in patients with MS compared to healthy subjects. A greater decrease in the Macruz index was associated with a successful PMBV.

Assessment of interatrial dyssynchrony by Tissue Doppler Imaging in mitral stenosis: Effect of afterload reduction after balloon mitral valvuloplasty

Abstract Background The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). After percutaneous mitral balloon valvuloplasty (PMBV), the improvement in echocardiographic parameters related to AF risk is unknown. We aimed to assess the interatrial electromechanical coupling by Tissue Doppler Imaging (TDI) echocardiography in MS before and after PBMV. Patients and methods This study included 45 patients with moderate to severe MS who underwent successful PMBV without complication at our clinic and 20 healthy volunteers as a control group. We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated one week after PMBV. Interatrial electromechanical delay (EMD) was measured by TDI before and after PMBV and we compared the results. Results The interatrial EMD (56.4 ± 15.8 vs. 34.6 ± 7.2 ms, p P -max) and P-wave dispersion (PWD) showed significant positive correlation with the interatrial EMD ( r = 0.37, p r = 0.41, p p Conclusion The current study showed significant increase in the interatrial EMD in patients with moderate to severe MS. These changes improved significantly after PMBV.

Correlation Between N-terminal Pro Brain Natriuretic Peptide and Right Ventricular Performance Measured by Doppler Echocardiography after Successful Percutaneous Balloon Mitral Valvuloplasty

Correlation Between N-terminal Pro Brain Natriuretic Peptide and Right Ventricular Performance Measured by Doppler Echocardiography after Successful Percutaneous Balloon Mitral Valvuloplasty

Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience

Objective: We sought to analyze short-term clinical, echocardiographic, and hemodynamic consequences of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of rheumatic mitral stenosis (MS) in our clinic. Methods: We retrospectively reviewed 53 patients (49 females, 5 males; mean age 38p11 years) who underwent PMBV for moderate or severe MS between January 2010 and October 2014. Procedural success was defined as the reaching a mitral valve area (MVA) >1.5 cm2 and absence of grade 3 mitral regurgitation. Results: We were able to perform PMBV in 48 of 53 patients (91%) and all the procedures that were completed were successful. PMBV couldn\'t be performed in 3 patients due to inability to pass the mitral valve, 1 patient due to membranous obstructive vena cava and 1 patient due inability to perform septostomi. Two patients who underwent successful PMBV became symptomatic after an average of 14 months follow-up and mitral valve replacement was performed due to moderate-to-severe MS. Patients were followed for an average of 13 p 8 months and atrial fibrillation development or embolic complications were not observed. Conclusion: Percutaneous mitral balloon valvuloplasty procedure is a safe and effective treatment approach with high success and low complication rates in experienced centers.

The effects of successful percutaneous mitral balloon valvuloplasty on acute and intermediate term aortic stiffness.

The aim of this study was to evaluate the effects of percutaneous mitral balloon valvuloplasty (PMBV) on short- and intermediate-term aortic stiffness in patients with mitral stenosis. This prospective study included 56 patients with critical mitral stenosis in normal sinus rhythm (68% female; mean age: 42 ± 11 years) and 37 healthy controls. Aortic stiffness was measured using transthoracic echocardiography before PMBV, and 24-48 hours and 1 year post procedure. Aortic strain and distensibility were significantly higher in the patients with mitral stenosis, both after PMBV and 1 year post procedure, whereas the aortic stiffness index (ASI) was significantly lower. There was also a significant decrease in mitral mean gradient (MMG) and systolic pulmonary artery pressure (sPAP) after PMBV, based on echocardiography and catheterization. Mitral valve area (MVA) significantly increased after PMBV. There was a significant correlation between change in ∆MVA and ∆MMG and aortic elastic properties. There was a significantly negative correlation between the ∆MVA and ∆∆ aortic stiffness (r = -0.62, P < 0.001), and a significantly positive correlation between ∆MMG and ∆ASI (r = 0.60, P < 0.001). Mitral valve stenosis was associated with impaired aortic stiffness and following PMBV, aortic stiffness decreased during both the acute period and the intermediate period.

Twenty year follow-up after successful percutaneous balloon mitral valvuloplasty in a large contemporary series of patients with mitral stenosis

BackgroundPercutaneous balloon mitral valvuloplasty (PMV) is currently considered the standard of care for suitable patients with rheumatic mitral stenosis. We sought to assess very long-term outcome after PMV. MethodsBetween 1991 and 2010, 482 consecutive patients underwent successful PMV in a single center. Procedural success was defined as post-procedural valve area≥1.5cm2 and regurgitation moderate or less, without in-hospital major adverse cardiac and cerebro-vascular events. The primary endpoint was 20-year incidence of major adverse cardiac events (MACE), including cardiovascular death and need for mitral surgery or repeat PMV. ResultsLong-term follow-up (mean 11.6±4.9years; range 0.5 to 20) was completed in 441 (91.5%) patients. The incidence of the primary endpoint was 41.9% (95% confidence interval [CI]: 37.3 to 46.7%). The rate of cardiovascular death, need for mitral surgery or repeat PMV was 9.1% (95% CI: 6.6 to 12.1), 27% (95% CI: 22.9 to 31.4), and 5.9% (95% CI: 3.9 to 8.5), respectively. Cumulative MACE-free survival at 20years was 35.9±4.7%. At multivariate analysis, male gender (hazard ratio [HR]: 1.99; 95% CI: 1.4–2.8, p<0.001), echocardiographic score>8 (HR: 2.19; 95% CI: 1.6–2.9, p<0.001), atrial fibrillation (HR: 1.54; 95% CI: 1.2–2.1, p=0.003) and valve area≤1.75cm2 after PMV (HR: 3.1; 95% CI: 2.3–4.2, p<0.001) were identified as independent predictors of the primary endpoint. ConclusionsUp to 20years after successful PMV, a sizeable proportion of patients still exhibit a good clinical result.

Echocardiographic effect of successful balloon mitral valvuloplasty on right ventricular function

Abstract Background Rheumatic cardiac disease is an immunologic phenomenon that may affect any of the heart valves and is by far the most common cause of mitral stenosis. Aim of the work To evaluate impact of successful percutaneous balloon mitral valvuloplasty on right ventricular function. Subjects and methods 30 consecutive patients who underwent balloon mitral valvuloplasty for rheumatic mitral stenosis between September 2010 and July 2011 at Ain Shams University hospital were included. All patients were subjected to transthoracic echo Doppler study, tissue Doppler imaging and TEE for: (A) Assessment of severity of mitral stenosis. (B) Peak myocardial velocities during systole, early and late diastole. (C) Assessment of RV function by measurement of TAPSE and Tie index. Results The study revealed a significant drop in TAPSE (before and 24 h after, P 0.008; before and 3 ms after, P 0.001) respectively. There was no significant change 24 h and 3 ms after the procedure ( P 0.220) .There was no significant change in IVC flow before and after 24 h ( P 0.221). There was no significant drop between before and after 3 ms ( P 0.062). There was no significant change between 24 h and 3 ms after the procedure ( P 0.264). There was a significant drop in Tie index (before and 24 h after, P 0.008; before and 3 ms after, P 0.009) respectively but no significant drop was found 24 h and 3 ms after the procedure ( P 0.373). Conclusion The current study showed a significant improvement in both systolic and diastolic functions of RV as observed by different echocardiographic parameters post BMV in patients without organic TV disease.

Impact of successful percutaneous balloon mitral valvuloplasty on pulmonary vascular resistance and right ventricular functions

Background Mitral stenosis (MS) still results in significant morbidity and mortality worldwide. Percutaneous balloon mitral “valvuloplasty” commissurotomy (PMC) as invasive, nonsurgical procedure is safe and effective therapeutic modality in selected patients with rheumatic MS. Right ventricular (RV) function abnormalities play an important role in the development of clinical symptoms and the overall prognosis of patients with MS, It occurs early before the systemic venous congestion develops, so it has been shown to be a major determinant of clinical outcome. Severe pulmonary hypertension (PH) is present in about 38% of severe MS cases. Pulmonary vascular disease frequently complicates long standing MS and may significantly influence prognosis. Non-invasive estimation of pulmonary vascular resistance (PVR) correlates strongly with invasive measures at both normal and elevated pulmonary pressures. Objectives Assess the effects of successful PMC on PVR and RV functions, immediately and after 6 month using new Doppler echocardiographic indices. Patient and methods 50 consecutive patients; 45 females (90%) & 5 males (10%) with isolated moderate and severe rheumatic MS underwent successful PMC. All of the following parameters were measured before PMC, Immediately after PMC and after 6 months of PMC using transthoracic echocardiography: Mitral valve area (MVA), peak diastolic pressure gradient (PDPG), mean diastolic pressure gradient (MDPG), pulmonary acceleration time (PAT), mean pulmonary artery pressure (MPAP), tricuspid regurge velocity (TRV), right ventricular systolic pressure (RVSP), right ventricular ejection fraction (RVEF), right ventricular outflow time velocity integral (RVOTTVI), right ventricular outflow tract fractional shortening (RVOTfs), tricuspid annular plane systolic excursion (TAPSE) and pulmonary vascular resistance (PVR) was calculated as PVR = TRVm/s/TVIRVOT cm x 10+ 0.16. Conclusions PMC has a very favorable impact on progressive and sustained improvement of RV functions, regression of pulmonary artery pressure and recovery of PVR (measured non-invasively) on short term and after 6 months of follow up. Regression of TRV was strong predictor for recovery of PVR and RVSP while improvement of RVOTFS was a strong predictor of recovery of RVEF.

Percutaneous balloon mitral valvuloplasty under neuroprotection

The case describes the successful percutaneous balloon mitral valvuloplasty under neuroprotection in a patient with severe symptomatic mitral stenosis and persistent left atrial appendage thrombus despite chronic warfarin therapy. Although the procedure was uneventful for any systemic embolism, the limitations of this approach are highlighted with authors still advocating that surgery remains the benchmark treatment for these patients. © 2014 Wiley Periodicals, Inc.

Evaluation of the long-term effect of percutaneous balloon valvuloplasty on right ventricular function using tissue Doppler imaging in patients with mitral stenosis

We investigated the effects of percutaneous mitral balloon valvuloplasty (PMBV) on right ventricular function in the long term using tissue Doppler imaging. Twenty-seven patients who underwent successful PMBV were enrolled in the study. Echocardiographic examination, including color tissue Doppler imaging, was done from the lateral tricuspid annulus 24 hours before the intervention, and the examination was repeated 24 hours and 6 months after the intervention. At 24 hours after the intervention, S wave velocity and A' wave velocity were seen to have increased significantly (9.52±1.85 cm/s vs. 10.92±1.20 cm/s, p=0.012; -10.44±2.64 cm/s vs. -11.73±2.05 cm/s, p=0.029, respectively). E' wave velocity and E'/A' ratio did not change significantly (p>0.05 for both). In the late period, S wave velocity was similar to the value in the early period and significantly higher than the basal level (9.52±1.85 cm/s vs. 10.69±1.72 cm/s, p=0.023). However, A' wave velocity in the late period was decreased compared to the early period and was not different from the basal level (-10.44±2.64 cm/s vs. -10.74±2.63 cm/s, p>0.05). The increase in E' wave velocity in the late period when compared to the basal level was found to be statistically significant (-7.85±1.54 cm/s vs. -9.21±1.81 cm/s, p=0.046). Right ventricular systolic function improved in the early period, and this improvement was seen to continue in the late period of PMBV. Diastolic function did not improve in the early period, but did improve in the late period. Right atrium systolic function improved in the early period; however, in the late period, levels were similar to the basal levels.

Repairs of an aortic root to right atrium iatrogenic fistula after unsuccessful percutaneous mitral valvuloplasty

We presented a case of a 37-year-old woman with atrial fibrillation, juvenile rheumatic arthritis, and severe rheumatic mitral stenosis, treated by successful percutaneous balloon mitral valvuloplasty in 2006, without cardiovascular risk factors. She presented disnea with class III of NYHA. The physical exam revealed …

Impact of Atrioventricular Compliance on Clinical Outcome of Patients Undergoing Successful Percutaneous Balloon Mitral Valvuloplasty

We aimed to assess the impact of atrioventricular compliance (Cn) on the clinical outcome, after successful percutaneous balloon mitral valvuloplasty (PBMV). Using Doppler echocardiography Cn was estimated from the equation that has been previously validated. Mitral valve area (MVA), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure (PAP), and degree of tricuspid regurgitation (TR) severity were evaluated before, immediately, and every 6months with a median duration of 32months after successful PBMV in 150 consecutive patients. An immediate drop in PAP and significant improvement of right ventricle (RV) function was observed after PBMV. Cn was negatively correlated pre and post-PBMV, with the degree of pulmonary artery systolic pressure (PAPs), TAPSE (P<0.0001). Patients with Cn≤3.75mL/mmHg had higher incidence of adverse outcome (developing atrial fibrillation [AF], worsening RV function, progressive left atrial dilation, and redo intervention). Multivariate regression analysis showed that the Cn was the strongest independent predictor of PAPs and RV function before and after successful PBMV (P<0.0001). Cn≤3.75mL/mmHg was the cutoff value for prediction of clinical events at follow-up. Atrioventricular compliance was significantly lower in patients with mitral stenosis (MS) with unfavorable outcome after successful PBMV. The RV function and pulmonary hypertension were significantly correlated with the degree of Cn. This suggests a significant role of Cn in patients with MS, providing a good insight for intervention and utilizing Cn as a noninvasive hemodynamic index for risk stratification and proper timing for intervention in patients with MS.

Impact of atrioventricular compliance on clinical outcome of patients undergoing successful percutaneous balloon mitral valvuloplasty

We aimed to assess the impact of atrioventricular compliance (Cn) on the clinical outcome, pulmonary hypertension (PH) and right ventricular (RV) function changes after successful percutaneous balloon mitral valvuloplasty (PBMV). Using Doppler echocardiography Cn was estimated from the equation that has been previously validated. Mitral valve area, tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure (PAP) and degree of TR severity were evaluated before, immediately and every 6 months with a median duration of 32 months after successful PBMV in 150 consecutive patients. Compared to control subjects patients with MS had significant lower Cn (P < 0.0001). An immediate drop in PAP and significant improvement of RV function was observed after PBMV. Cn was correlated with the degree of PAPs, TAPSE (P < 0.0001). Patients with Cn < 3.75 mL/mmHg had higher incidence of adverse outcome (developing atrial fibrillation, worsening RV function, progressive left atrial dilation and redo intervention). Multivariate regression analysis showed that the Cn was the strongest independent predictor of PAPs and RV functional before and after successful PBMV (P < 0.0001). Cn < 3.75 mL/mmHg was the cut-of value for prediction of clinical events at follow-up. The change and follow-up in RV function and pulmonary hypertension after successful PBMV were significantly correlated with the degree of Cn. This suggests a significant role of Cn in patients with MS, providing a good insight for intervention and utilizing Cn as a non-invasive hemodynamic index for risk stratification and proper timing for intervention in patients with MS.

Intracardiac echocardiography-guided percutaneous mitral balloon valvuloplasty

Percutaneous mitral balloon valvuloplasty (PMBV) was initially described by Inoue in 1984 as a novel percutaneous technique for the management of mitral stenosis. Intracardiac echocardiography was initially used in the 1980s but was not universally accepted due to its high-frequency transducers and problems with steerability and manipulation. In the 1990s technical improvements led to more generalized use in various structural interventional procedures. We present the case of a successful PMBV guided exclusively by ICE.

Intracardiac echocardiography-guided percutaneous mitral balloon valvuloplasty

Percutaneous mitral balloon valvuloplasty (PMBV) was initially described by Inoue in 1984 as a novel percutaneous technique for the management of mitral stenosis. Intracardiac echocardiography was initially used in the 1980s but was not universally accepted due to its high-frequency transducers and problems with steerability and manipulation. In the 1990s technical improvements led to more generalized use in various structural interventional procedures. We present the case of a successful PMBV guided exclusively by ICE.

The prognostic impact of P wave dispersion in prediction of clinical outcome after percutaneous balloon mitarl valvuloplasty in patients with mitral stenosis and sinus rhythm

Objective: The aim of the study was to investigate the impact of P-maximum and P-wave dispersion on the long term clinical outcome after successful percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis (MS) and sinus rhythm. Also to test the correlation between P-variables and right ventricular function and pulmonary artery pressure before and after PMBV. Methods: Eighty-five patients undergoing PMBV were enrolled in this study. We evaluated P-maximum, P-minimum and P-wave dispersion before and one month after PBMV. We studied the changes in pulmonary arterial pressure (PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve area, in addition to the changes in right ventricular function utilizing tissue Doppler assessment both before and after PMBV, in addition the role of the P-wave dispersion in predicttion of late cardiac events. Results: There were significant decreases in mean diastolic gradient, PAP, and LA size and significant improvement in right ventricular tissue Doppler indices after PMBV. Ac- company these hemodynamic changes after PMBV. P-maximum and P-wave dispersion were found to be decreased (P off values of ≥62.8 msec for P-wave dispersion and 118 mes for P-maximum.ROC curve showed AUC of 0.919 for P-wave dispersion and 0.913 for P-maximum (P

Delayed cardiac asystole after percuteneous mitral balloon valvuloplasty

Percutaneous mitral balloon valvuloplasty (PMBV) is the preferred treatment in mitral stenosis patients with appropriate valve anatomy, but it may cause arrhythmic complications rarely. In the literature, the mortality rate associated with PMBV has been reported as 1%, and a small number of patients developed atrioventricular block during the process. In this report, we describe a 53-year-old female patient with severe rheumatic mitral stenosis who developed Mobitz type 2 atrioventricular block and asystole after a successful PMBV operation. Sinus rhythm was achieved with atropine in this patient. It was thought that the arrhythmia resulted from calcified plaques on the mitral valve or from conduction system damage due to high balloon pressure during the process. For the recognition and treatment of possible arrhythmic complications, it is important to monitor patients in the intensive care unit for at least 24 hours after PMBV.

Successful percutaneous balloon mitral valvuloplasty in patients with left atrial appendage thrombus

Successful percutaneous balloon mitral valvuloplasty in patients with left atrial appendage thrombus

P wave dispersion as a valuable marker in prediction of outcome of tricuspid regurgitation and improved right ventricular function after percutaneous balloon mitarl valvuloplasty in patients with mitral stenosis

To investigate the impact of P-wave dispersion (PWD) outcome of tricuspid regurgitation (TR) and right ventricular (RV) function after successful percutaneous mitral balloon valvuloplasty (PMBV) in patients with mitral stenosis (MS) and sinus rhythm. Seventy-eight consecutive patients undergoing PMBV were enrolled in this study. We evaluated PWD before and 1 month after PBMV. We studied the TR severity and RV function, in addition to the changes in pulmonary artery pressure (PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve area, the changes before and after PMBV. Patients with TR regression and improved RV function were classified as group A and those without regression of TR were classified as group B. There were significant decreases in mean diastolic gradient, PAP, and LA size, significant regression of TR from moderate-severe TR to mild TR and improvement in RV function after PMBV. PWD significantly decreased (P < 0.001). Group B patients during follow-up had a higher PWD than those in group A (P < 0.001). It was revealed with linear regression and correlation analysis that the degree of changes in PWD were correlated with development of regression of TR and improved RV funcion after PMBV. P-wave maximum and dispersion are significantly increased in patients with MS. They decreased significantly after PMBV. They were significantly correlated with TR severity and impairment of right ventricular function and the degree of PAP. P maximum and dispersion could be considered as independent predictors of TR regression and improved RV functionin patients with MS after PMBV.