Surgical Commissurotomy Research Articles

Three-dimensional Echocardiography during Percutaneous Mitral Balloon Valvuloplasty

Percutaneous mitral balloon valvuloplasty (PMBV) has been frequently used as an alternative to open or closed surgical mitral commissurotomy for the treatment of selected patients with symptomatic rheumatic mitral stenosis. PMBV has been proven a safe and effective method, often performed under fluoroscopic guidance. With the advent of three-dimensional echocardiography (3DE), interventional cardiologists have been able to successfully perform complex procedures such as paravalvular leak closure, transcatheter edge-to-edge repair of the mitral valve (MV) using MitraClip, etc. With the expertise derived from these procedures, 3DE has received considerable interests in many other procedures, including PMBV. Pre-, intra-, and postprocedural assessments of the mitral valve (MV) area; commissural splitting; the presence, degree, and location of mitral regurgitation; and other procedure-related complications can be more accurately and readily made using 3DE. In addition, real-time 3D transesophageal echocardiography has been proven to be more accurate than two-dimensional (2D) techniques in identifying specific MV abnormalities associated with complex diseases. Moreover, real-time 3DE offers the advantage of shorter fluoroscopy and radiation times throughout PMBV. This article reviews the use of 3DE during PMBV in light of the most recent literature and based on expertise and discusses the pros and cons of 3DE, with emphasis on its superiority to conventional 2D echocardiography.

Diagnostic accuracy of total echo score and total commissural morphology score for the prediction of outcome after percutaneous transvenous mitral commissurotomy (PTMC)

INTRODUCTION: Percutaneous transvenous mitral commissurotomy (PTMC), a procedure that treats certain individuals with mitral stenosis, is now frequently used as an alternative to closed surgical mitral commissurotomy (CMC). Cardiologists disagree on which is superior when comparing the total echo score (also known as the Wilkin's score) and the commissural morphology score (TC) for predicting excellent and bad outcomes of PTMC procedures. Therefore, we created this study so that a good predictive score can be used in the future with supporting data before PTMC.
 AIMS & OBJECTIVE: To evaluate the diagnostic efficacy of the total echo score and the total commissural morphology score for the prognosis following percutaneous transvenous mitral commissurotomy (PTMC).
 MATERIALS & METHODS: This research was a cross-sectional analysis of patients at the Punjab Institute of Cardiology. This research took place over the course of 6 months, from August 20, 2014 to February 20, 2015. A total of 110 participants participated in the study.
 RESULTS: The mean age of patients in this study was 43.80 ± 14.18 years with 49(44.5%) males and 61(55.5%) female patients in this study. According to operational definition success of procedure was seen in 103(93.6%) of the patients while 7(6.4%) had unsuccessful procedure. On comparing Total Echo score and “successful procedure” the sensitivity and specificity of Total echo score was 83.5% and 85.71% while PPV and NPV were 98.85% and 26.09% respectively with diagnostic accuracy of 83.64%. The sensitivity and specificity of Commissural score was 92.23% and 57.14% while PPV and NPV were 96.94% and 36.33% respectively with diagnostic accuracy of 90%.
 CONCLUSION: Total ECO score has high sensitivity, specificity and over diagnostic accuracy but total commissural morphology score has high sensitivity but with less specificity with high diagnostic score. So total echo score can be used as predictive tool for outcome of PTMC in our population
 KEYWORDS: Rheumatic Heart Disease, Mitral Stenosis, PTMC, Mitral Commissurotomy

History of PTMC at National Institute of Cardiovascular Diseases Karachi.

Rheumatic mitral stenosis (MS) incidence and severity rates have decreased in the developed world, but the condition is still very common in many nations. Since its invention, percutaneous mitral balloon valvuloplasty has transformed the therapy of mitral stenosis, shown promising short- and long-term outcomes, and taken the role of surgical mitral commissurotomy as the preferred method of managing rheumatic mitral stenosis in suitable patients. The morphologic characteristics of the valve leaflets and sub valvular structures can be used to predict the possibility of hemodynamic benefit and the danger of complications with balloon valvuloplasty. The results will be less than ideal if the valves are hard, thickened, and extensively calcified. We presented the retrospective data of approximately 500 patients from March 2001 to June 2006 in this paper.

Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

CRT-700.53 Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

CRT-700.53 Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

Factors predicting mitral restenosis after successful percutaneous mitral commissurotomy

Percutaneous mitral commissurotomy (PMC) is the alternative treatment of choice for mitral stenosis (MS). Its immediate and medium term results are comparable to those of surgical commissurotomy, however in the long term there is a risk of restenosis. The purpose of this study is to determine the factors predicting restenosis after PMC. Three hundred and twenty-two patients (66% women), average age: 35 ± 13 years (9–75 years) having a tight MS and treated by PMC with Inoué balloon. The anatomic aspect of the mitral apparatus before PMC has been studied according to the criteria of the Wilkins score with a concomitant study of the state of mitral commissures. The primary success of PMC is defined as follows: mitral area (MA) post-PMC >1,5 cm2 and gain in MA > 25% and mitral regurgitation (MR) ≤ grade 2. Mitral restenosis is defined as a MA < 1,5 cm2 and/or loss > 50% of initial gain in MA. The rate of primary success of PMC was 86% and mean MA post PMC was 1,82 ± 0,33 cm2 compared to MA pre-PMC of 1 ± 0,18 cm2 (P < 0.0001). Opening of two commissures has been observed in 74% of patients. After an average period of 62 ± 32 months, only 12% of patients had a dyspnea stage III-IV of NYHA, MA was 1,64 ± 0.3 cm2 (P < 0.001) and mitral restenosis happened in 47 patients (20%) after a period of 60,48 ± 27 months (22–124 months). The independent predictors of mitral restenosis after a successful PMC were: previous surgical commisurotomy, Wilkins score > 8, MA after PMC < 1,8 cm2 and absence of bicommissural opening post PMC. A favorable anatomy of mitral apparatus and the optimisation of immediate result of PMC are the guaranty for the maintain of good result in the long term.

BALLOON VALVULOPLASTY VERSUS SURGICAL VALVOTOMY FOR CONGENITAL AORTIC STENOSIS: SYSTEMATIC REVIEW AND META-ANALYSIS

<h3>BACKGROUND</h3> The debate between the best therapeutic approach to congenital aortic stenosis is ongoing. Multiple studies have attempted to answer this question without reaching a definitive conclusion. McCrindle et al performed the landmark analysis of the congenital heart surgeon database and they showed equivalent results in the outcome between surgical aortic valvotomy (SAV) versus balloon aortic valvuloplasty (BAV). Given similar outcomes, many centers preferentially perform BAV due to its minimally invasive nature and faster recovery. Some more recent single-center studies have shown better outcomes with surgical valvotomy; however, their results were attributed to the use of contemporary superior surgical techniques. In this study, we perform a contemporary systematic review and meta-analysis to compare the effects of BAV and SAV on patient morbidity and mortality. <h3>METHODS AND RESULTS</h3> We searched MEDLINE and EMBASE from inception to March 2021 for studies comparing balloon aortic valvuloplasty versus surgical commissurotomy for critical congenital AS in patients younger than 18. We performed title and abstract screening, full-text assessment, risk of bias assessment using the CLARITY tool, and data collection independently and in duplicate. We pooled data using the random-effects model and Mantel-Haensel statistical method. We evaluated the overall quality of evidence using the GRADE framework. From a total of 439 studies imported for screening, 12 studies (1214 participants) were included that compared outcomes for balloon aortic valvuloplasty and surgical commissurotomy in the pediatric population. Mortality at 30-day and at longest follow-up was not statistically significant between the two groups (RR 0.66 95% CI [0.34, 1.27] and 0.74 95% CI [0.35, 1.56]. Reintervention favoured surgical repair at the longest follow-up but did not reach statistical significance (RR 1.11 95% CI [0.89, 1.38]). Postprocedural aortic insufficiency was more common after balloon valvotomy but failed to reach statistical significance (RR: 1.5 95% CI 0.99 – 2.99). <h3>CONCLUSION</h3> In pediatric patients with congenital AS, surgical commissurotomy did not offer additional advantages over balloon valvotomy. There was a trend toward an increase in post-procedural AI and an increased rate of reintervention with balloon valvotomy. However, the quality of evidence is very low. An appropriately powered large study is required to adequately address the risks and benefits of the two interventions.

Prior surgical mitral commissurotomy and echocardiographic score influence in mitral balloon valvuloplasty. Immediate post procedure results

Abstract Introduction Percutaneous mitral balloon valvuloplasty is effective in mitral stenosis. Objectives: to evaluate prior mitral surgical commissurotomy (PMC) and echocardiographic score (ES) in the results and complications of mitral balloon valvuloplasty (MBV). Methods From 1987 to 2013, 526 procedures with Inoue balloon, double or single Balt balloon technique; 480 without PMC named primary MBV group (PMBVG) and 46 that have been submitted to PMC, the PMC group. The PMCG was older than PMBVG (42.7±12.4 vs 36.9±12.5 years, p=0.0030). Gender, atrial fibrilation and NYHA functional class were similar. In PMBVG and PMCG, respectively, ES were 7.2±1,4 and 7.7±1.5 points (p=0.0158) and mitral valve area (MVA) 0.94±0.21 and 1.00±0.22 cm2 (p=0.0699). Results Pre-MBV: mean pulmonary artery pressures (MPAP) were 37.8±14.2 and 37.6±14.4 mmHg, p=0.9515; mean gradient (MG) 19.6±6.9 and 18.3±6.9 mmHg, p=0.2342; MVA 0.90±0.21 and 0.93±0.19 cm2, p=0.4092, respectively, whem compare PMBVG and PMCG. Post-MBV: MPAP were 26.8±10.2 and 26.6±10.9 mmHg, p=0.9062; MG 5.4±3.5 and 6.3±4.2 mmHg, p=0.1492; MVA 2.04±0.42 and 1.92±0.41 cm2, p=0.0801, respectively. Mitral regurgitation (MR) were similar pre and post-MBV. Severe MR post-MBV in 10 patients: 8 in PMBVG and 2 in PMCG, p=0.2048. As there were not found significant diferences, the total group were divided in ES ≤8 and &amp;gt;8 groups: Pre-MBV: MPAP 37.5±13.9 and 39.3±16.6 mmHg, p=0.4041; MG 19.7±6.8 and 18.3±7.3 mmHg, p=0.1753; MVA 0.90±0.21 and 0.94±0.20 cm2, p=0.0090 respectively. Post-MBV: MPAP 26.7±10.1 and 28.0±10.6 mmHg, p=0.3730, MG 5.5±3.6 and 5.5±3.3 mmHg, MVA 2.06±0.42 and 1.90±0.40 cm2, p=0.0090. Conclusion The groups with and without prior mitral commissurotomy in MBV were compare and no differences were found in pre- and post-procedure, as mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Although PMCG was older, with higher ES, its hemodynamics datas were similar. Whem the entire group was divided based on echo scores, those with echo scores &amp;gt;8 had highse MV (p=0.0090). and smaler mitral valve areas post-valvuloplasty. The valve anatomy were more important than prior commissurotomy. Funding Acknowledgement Type of funding source: None

Surgical rheumatic mitral valve repair compared with percutaneous balloon mitral valvuloplasty in mitral stenosis in current era: a propensity score matching study.

BackgroundMany comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with “four-step” procedure in the treatment of rheumatic MS.MethodsPatients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences.ResultsA total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP. Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm2, P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively. Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent re-intervention in rMVP, but one patient died of pneumonia.ConclusionsFor selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with “four-step” procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).

Percutaneous mitral balloon valvuloplasty - state of the art

Since its introduction in 1982, percutaneous mitral balloon valvuloplasty (PMV) has been used successfully as an alternative to open or closed surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. PMV is safe and effective and provides sustained clinical and hemodynamic improvement in patients with mitral stenosis. The immediate and long-term results appear to be similar to those of surgical mitral commissurotomy. Proper patient selection is an essential step for being able to predict the immediate results of PMV. Candidates for PMV require precise assessment of the mitral valve morphology. The Wilkin’s echocardiographic score (Echo-Sc) is currently the most widely used method for predicting PMV outcome. Leaflet mobility, leaflet thickening, valvular calcification, and sub valvular disease are each scored from 1 to 4. An inverse relationship exists between the Echo-Sc and PMV success. Both immediate and intermediate follow-up studies have shown that patients with Echo-Sc ≤ 8 have superior results, significantly greater survival, and event free survival compared to patients with Echo-Sc &gt; 8. We identified other clinical and morphologic predictors of PMV success that include age, pre-PMV mitral valve area, history of previous surgical commissurotomy, and mitral regurgitation (MR), and post-PMV variables (e.g., post-PMV MR ≥ 3 + and pulmonary artery pressure), that may be used in conjunction with the Echo-Sc to optimally identify candidates for PMV. This concept demonstrates a multifactorial nature of the prediction of immediate and long-term results. Other echocardiographic scores have been developed for the screening of potential candidates for PMV. They include a unique score that take into account the length of the chordae. A novel quantitative score that included the ratio of the commissural areas over the maximal excursion of the leaflets from the annulus in diastole. The components of this score include mitral valve area ≤ 1 cm2, maximum leaflet displacement ≤ 12 mm, commissural area ratio ≥ 1.25, and sub valvular involvement. Finally, a score that is able to identify patients who are more likely to develop significant mitral regurgitation post-PMV. This score takes into account the distribution (even or uneven) of leaflet thickening and calcification, the degree and symmetry of commissural disease, and the severity of subvalvular disease. The transvenous transseptal approach is the most widely used PMV technique. The two major techniques of PMV are the double-balloon technique and the Inoue technique which are equally effective techniques of PMV. Encouraging results of PMV have been reported in special mitral stenosis population cohorts including pregnant women, patients with previous surgical commissurotomy, patients with atrial fibrillation, patients with pulmonary hypertension, elderly patients, patients with calcific mitral stenosis, and patients with associated aortic regurgitation. To summarize, PMV is the preferred form of therapy for relief of mitral stenosis for a selected group of patients with symptomatic mitral stenosis and suitable valve anatomy for valvuloplasty. Patients with Echo-Sc ≤ 8 have the best results, particularly if they are young, are in normal sinus rhythm, have no pulmonary hypertension, and have no evidence of calcification of the mitral valve under fluoroscopy. The immediate and long-term results of PMV in this group of patients are similar to those reported after surgical mitral commissurotomy. Patients with Echo-Sc &gt; 8 have only a 50% chance to obtain a successful hemodynamic result with PMV, and the long-term follow-up results are worse than those from patients with Echo-Sc ≤ 8. In patients with Echo-Sc ≥ 12, it is unlikely that PMV could produce good immediate or long-term results and they preferably should undergo mitral valve replacement. However, PMV could be considered in these patients if they are high-risk or unqualified surgical candidates.

Percutaneous mitral commissurotomy versus surgical commissurotomy for rheumatic mitral stenosis: a systematic review and meta-analysis of randomised controlled trials

AimPatients with severe mitral stenosis (MS) and their clinicians typically choose percutaneous transvenous mitral commissurotomy (PTMC) over surgical commissurotomy (SC). However, the durability of PTMC relative to SC is uncertain....

Predictors of Complications during Percutaneous Multitrack Balloon Mitral Valvuloplasty

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

Factors predicting mitral restenosis after successful percutaneous mitral commissurotomy

Percutaneous mitral commissurotomy (PMC) is the alternative treatment of choice for mitral stenosis (MS). Its immediate and medium term results are comparable to those of surgical commissurotomy, however in the long term there is a risk of restenosis. The purpose of this study is to determine the factors predicting restenosis after PMC. 322 patients (66% women), average age: 35 ± 3 years (9–75 years) having a tight MS and treated by PMC with Inoué balloon. The anatomic aspect of the mitral apparatus before PMC has been studied according to the criteria of the Wilkins score with a concomitant study of the state of mitral commissures. The primary success of PMC is defined as follows: mitral area (MA) post-PMC > 1.5 cm 2 and gain in MA > 25% and mitral regurgitation (MR) ≤ grade 2. Mitral restenosis is defined as a MA < 1.5 cm 2 and/or loss > 50% of initial gain in MA. The rate of primary success of PMC was 86% and mean MA post PMC was 1.82 ± 0.33 cm 2 compared to MA pre-PMC of 1 ± 0.18 cm 2 ( P < 0.0001). Opening of two commissures has been observed in 74% of patients. After an average period of 62 ± 32 months, only 12% of patients had a dyspnea stage III-IV of NYHA, MA was 1.64 ± 0.3 cm 2 ( P < 0.001) and mitral restenosis happened in 47 patients (20%) after a period of 60.48 ± 27 months (22–124 months). The independent predictors of mitral restenosis after a successful PMC were: previous surgical commisurotomy, Wilkins score > 8, MA after PMC < 1.8 cm 2 and absence of bicommissural opening post PMC. A favorable anatomy of mitral apparatus and the optimisation of immediate result of PMC are the guaranty for the maintenance of good result in the long term.

PO624 Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence In Mitral Balloon Valvuloplasty. Immediate Post Procedure Results

PO624 Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence In Mitral Balloon Valvuloplasty. Immediate Post Procedure Results

Endovascular Therapy for Rheumatic Mitral and Aortic Valve Disease: Review Article.

Rheumatic heart disease remains a major cause of significant mortality and morbidity in the developing world. Rheumatic mitral and aortic stenosis are the two most common valvular sequelae of acute rheumatic fever. Open surgical procedures with either valve replacement or surgical commissurotomy have largely been replaced by percutaneous commissurotomy and balloon valvuloplasty for selected patients since the early 1980s. The purpose of our review is to examine the literature for any recent advancement in procedural techniques of balloon valvuloplasty for selected patients with rheumatic mitral and or aortic stenosis. Our search indicates that, in general, the volume of recent publications on this important topic is rather scanty with no major changes in the fundamentals of procedural techniques and or primary indications for balloon valvuloplasty of a rheumatic valve stenosis. Percutaneous balloon valvuloplasty/commissurotomy remains the main stay of therapy for rheumatic valvular stenosis in selected patients with favorable valve anatomy.

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

Factors predicting mitral restenosis after successful percutaneous mitral commissurotomy

Percutaneous mitral commissurotomy (PMC) is the alternative treatment of choice for mitral stenosis (MS). Its immediate and medium term results are comparable to those of surgical commissurotomy, however in the long-term there is a risk of restenosis. The purpose of this study was to determine the factors predicting restenosis after PMC. Fifty patients (66% women), average age: 35 ± 13 years (9–75 years) having a tight MS and treated by PMC with Inoué balloon. The anatomic aspect of the mitral apparatus before PMC has been studied according to the criteria of the Wilkins score with a concomitant study of the state of mitral commissures. The primary success of PMC was defined as follows: mitral area (MA) post-PMC > 1,5 cm 2 and gain in MA > 25% and mitral regurgitation (MR) ≤ grade 2. Mitral restenosis is defined as a MA < 1,5 cm 2 and/or loss > 50% of initial gain in MA. The rate of primary success of PMC was 86% and mean MA post-PMC was 1,82 ± 0,33 cm 2 compared to MA pre-PMC of 1 ± 0,18 cm 2 ( P < 0.0001). Opening of two commissures has been observed in 74% of patients. After an average period of 62 ± 32 months, only 12% of patients had a dyspnea stage III-IV of NYHA, MA was 1,64 ± 0.3 cm 2 ( P < 0.001) and mitral restenosis happened in 20% of patients after a period of 60,48 ± 27 months (22–124 months). The independent predictors of mitral restenosis after a successful PMC were: previous surgical commisurotomy, Wilkins score > 8, MA after PMC < 1,8 cm 2 and absence of bicommissural opening post-PMC. A favorable anatomy of mitral apparatus and the optimization of immediate result of PMC are the guaranty for the maintenance of good result in the long-term.

Factors predicting mitral restenosis after successful percutaneous mitral commissurotomy

Percutaneous mitral commissurotomy (PMC) is the alternative treatment of choice for mitral stenosis (MS). Its immediate and medium term results are comparable to those of surgical commissurotomy, however in the long-term there is a risk of restenosis. The purpose of this study is to determine the factors predicting restenosis after PMC. 322 patients (66% women), average age: 35 ± 13 years (9–75 years) having a tight MS and treated by PMC with Inoué balloon. The anatomic aspect of the mitral apparatus before PMC has been studied according to the criteria of the Wilkins score with a concomitant study of the state of mitral commissures. The primary success of PMC is defined as follows: mitral area (MA) post-PMC > 1,5 cm 2 and gain in MA > 25% and mitral regurgitation (MR) ≤ grade 2. Mitral restenosis is defined as a MA < 1,5 cm 2 and/or loss > 50% of initial gain in MA. The rate of primary success of PMC was 86% and mean MA post PMC was 1,82 ± 0,33 cm 2 compared to MA pre-PMC of 1 ± 0,18 cm 2 ( P < 0.0001). Opening of two commissures has been observed in 74% of patients. After an average period of 62 ± 32 months, only 12% of patients had a dyspnea stage III-IV of NYHA, MA was 1,64 ± 0.3 cm 2 ( P < 0.001) and mitral restenosis happened in 47 patients (20%) after a period of 60,48 ± 27 months (22–124 months). The independent predictors of mitral restenosis after a successful PMC were: previous surgical commisurotomy, Wilkins score > 8, MA after PMC < 1,8 cm 2 and absence of bicommissural opening post-PMC. A favorable anatomy of mitral apparatus and the optimization of immediate result of PMC are the guaranty for the maintenance of good result in the long-term.

Complications of repeat percutaneous mitral valvuloplasty

Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy Compared with surgery, PMV is associated with shorter hospital stays, reduced patient discomfort, and significantly lower costs. However, it is unknown whether patients who developed symptomatic mitral restenosis after PMV may benefit from repeat PMV (re-PMV) with safety. This study was designed to evaluate the occurrence rate and the predictive factors for severe complications following re-PMV. Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon at 8 ± 4 years after prior procedure. A clinical and ultrasound follow-up was achieved in 31 patients with a mean follow-up period of 43 ± 26 months. The mean age of patients was 43 ± 11 years [23; 63], 87,5% of the population being female (5 men and 35 women). The immediate procedural success was achieved in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in 3 patients (7.5%). A cerebrovascular stroke occurred in 1 patient (2.5%). No procedure-related death or cardiac tamponade were noted. Only a left atrial area ≤ 25 cm 2 was linked to high risk of severe MR. At long-term, mitral restenosis was observed in 13 patients (42%) at 53 ± 30 months [9; 128] after re-PMV, 2 patients presented thromboembolic events (6%) and no death. Only the male had been identified as a predictor of restenosis. The feasibility of re-PMV with a relatively high procedural success rate and an acceptable complication profile makes it an appealing therapeutic strategy for patients with recurrent valve stenosis. The improved experience of our medical teams, and the systematic use of transoesophageal echocardiography to detect thrombi explain the low incidence of the complications of re-PMV in our study.

Post Rheumatic Tricuspid Valve Disease Associated to a Left Atrial Mass in a Young Female: a Case Report

Primary lesions of the tricuspid valve are rare Tricuspid disease is an uncommon valvular abnormality that most commonly occurs in association with other valvular lesions particularly in patients with rheumatic heart disease For many years surgical commissurotomy and valvuloplasty were the only available methods to correct tricuspid disease We present a case of post rheumatic disease of the tricuspid valve in a young girl associated to a left atrial mass nbsp