Valve Area In Patients Research Articles

117 Real-time 3D transoesophageal echocardiography evaluation of the mitral valve area in patients with mitral stenosis

Planimetry measured by two-dimensional transthoracic echocardiography (TTE, MVA2D) is the reference method for the evaluation of the severity of mitral stenosis (MS) but is significantly less reliable when performed by non-experienced operators and when transthoracic echogenicity is poor. Real-time three-dimensional transoesophageal echocardiography (RT3DTEE, MVA3D) may overcome those limitations but its accuracy has never been evaluated. We prospectively enrolled 43 patients (59 ± 15 years, 86% female) referred for MS evaluation who underwent the same day a TTE and a RT3DTEE. MVA2D was assessed by experienced operators, MVA3D was measured by one experienced (Level III) and one non-experienced operator (Level I) blinded of any clinical and TTE information. RT3DTEE images were digitally stored and analysed offline on a workstation using dedicated software (QLab, Philips) in a random order. MVA3D was measured at the best cross section of the mitral valve defined as the most perpendicular and smallest orifice. MVA3D measured by the experienced operator (1.07 ± 0.31 cm2 [range 0.45–1.85]) did not differ from and correlated well with MVA2D (1.08 ± 0.32 cm2 [range 0.54–2.00], p = 0.84, r = 0.71, p < 0.001), and mean difference was small (−0.01 ± 0.24 cm2). Similarly, the MVA3D measured by the non-experienced operator (1.03 ± 0.31 cm2 [range 0.45–1.69]) did not differ from and correlated well with MVA2D (p = 0.27, r = 0.66, p < 0.001; mean difference −0.05 ± 0.26 cm2). RT3DTEE intra and interobserver (between experienced and non-experienced operators) variability were respectively 0.13 ± 0.10 cm2 and 0.19 ± 0.14 cm2. RT3DTEE provides accurate and reproducible MVA measurements similar to 2D planimetry performed by experienced operators. Thus, RT3DTEE should be considered as an alternative tool for the evaluation of MS severity, especially in patients with poor echocardiographic windows or for team less accustomed to evaluate patients with MS.

External nasal valve collapse - a case-control and interventional study employ-ing a novel internal nasal dilator (NasanitaA(r))

Nasal alar collapse is a common problem and difficult to assess and treat. In 10 healthy controls and 10 patients with alar collapse, the size of the external nasal valve was analyzed on standardized nasal base photographs during quiet breathing and forced inspiration. A novel internal nasal dilator (Nasanita, Siemens & Co, Germany) was employed to assess the effects of a therapeutic intervention. In addition, active anterior rhinomanometry was performed. During quiet breathing, the external nasal valves were significantly smaller in patients with alar collapse (0.3 +/- 0.08 cm2) than in controls (0.7 +/- 0.2 cm2; p < 0.001). In heal-thy controls, forced inspiration did not significantly alter the size of the external nasal valve (-1.8% +/- 27.5%; p = 0.84), whereas it significantly decreased the external valve area in patients with alar collapse (-42.1% +/- 26.4%; p = 0.001). The internal nasal dilator significantly increased external valve areas during quiet breathing and forced inspiration and completely abolished alar collapse. Nasal airflow at a transnasal pressure difference of 150 Pa was not correlated with external valve size. Nasal airflow increased significantly after inserting the internal nasal dilator to 1300 +/- 370 ml/s (p < 0.001) in controls and 1300 +/-300 ml/s (p < 0.01) in patients. A small sized external nasal valve appears to be a major causative factor of alar collapse. A novel internal nasal dilator effectively enlarged the external nasal valve, abolished alar collapse and improved nasal airflow.

Significance of transesophageal echocardiography in the evaluation of aortic valve stenosis

Transesophageal echocardiography (TEE) is a relatively new diagnostic method offering better resolution of cardiac anatomy than the conventional transthoracal two-dimensional echocardiography (TTE). Clinical indications for TEE have been expanding, thus the technique as a diagnostic procedure is used in numerous cardiac diseases such as endocarditis, congenital heart defect, aortic dissection, prosthetic valves dysfunction, as well as in calculation of aortic valve surface in aortic stenosis. The aim of the study was to prove TEE as a more precise method in determination of the level of seriousness of aortic valve stenosis. All the patients went through TTE and TEE. Evaluating of the aortic valve surface was performed by the use of Gorlin's formula in TTE while it was planimetric in TEE examination. Comparative analysis of all parameters obtained by TTE and TEE showed a difference between them. All the parameters values except that for surface area of the aortic valve orifice confluence were higher in TEE than in TTE examination, but no difference was statistically significant (p > 0.05; t-test for a dependant specimens). By the use of the TTE method, the size of aortic orifice stenosis was 1.22 +/- 0.54 cm2, and by the TEE method it was 1.08 +/- 0.54 cm2. CONCLUSION. Multiplain TEE is reliable in quantification of an aortic valve area in patients with aortic stenosis. It offers useful clinical information, particularly in patients with non-adequate evaluation with TE, as well as in seriously ill patients or those with a confirmed valvular defect.

Comparison of Dual-Source Computed Tomography for the Quantification of the Aortic Valve Area in Patients With Aortic Stenosis Versus Transthoracic Echocardiography and Invasive Hemodynamic Assessment

We compared the measurements of the aortic valve area (AVA) using dual-source computed tomography (DSCT) in patients with mid to severe aortic stenosis to measurements using transthoracic echocardiography (TTE) and invasive hemodynamic assessment. A total of 50 patients (mean age 73 +/- 10 years) with suspected aortic stenosis were included. The computed tomographic data were acquired using DSCT with standardized scan parameters (2 x 64 x 0.6 mm collimation, 330-ms rotation, 120-kV tube voltage, 560 mA/rot tube current). After injection of 35 ml contrast agent (flow rate 5 ml/s), a targeted volume data set, ranging from the top of the leaflets to the infundibulum, was acquired. Ten cross-sectional data sets (slice thickness 1 mm, no overlap, increment 0.6 mm) were reconstructed during systole in 5% increments of the R-R interval. The AVA determined in systole by planimetry was compared to the calculated AVA values using the continuity equation on TTE and the Gorlin formula on catheterization. DSCT allowed the planimetry of the AVA in all patients. The mean AVA using DSCT was 1.16 +/- 0.47 cm(2) compared to a mean AVA of 1.04 +/- 0.45 cm(2) using TTE and 1.06 +/- 0.45 cm(2) using catheterization, with a significant correlation between DSCT/TTE (r = 0.93, p <0.001) and DSCT/cardiac catheterization (r = 0.97, p <0.001). However, DSCT demonstrated a slight, but significant, overestimation of the AVA compared to TTE (+0.12 +/- 0.17 cm) and catheterization (+0.10 +/- 0.12 cm(2)). In conclusion, DSCT permits one to assess the AVA with a high-image quality and diagnostic accuracy compared to TTE and invasive determination.

Ejection fraction-velocity ratio for the assessment of aortic bioprosthetic valves in patients with systolic dysfunction

The continuity equation (CE) represents the 'gold standard' for the evaluation of aortic valve area in patients with aortic stenosis, but it is time-consuming and subject to error, and can be technically demanding. Recently, a new echocardiographic nonflow corrected index was introduced and demonstrated excellent accuracy in quantifying the effective orifice area (EOA) in native aortic valves and bioprostheses. This new index, the ejection fraction (EF)-velocity ratio (EFVR), is obtained by dividing the percentage left ventricular EF by the maximum aortic gradient. To assess the usefulness of this echocardiographic index for quantifying the EOA in patients with aortic bioprosthesis and left ventricular dysfunction. A total of 70 patients (25 women and 45 men) with aortic bioprosthesis and left ventricular dysfunction (EF of 49% or less) were studied. The mean (+/- SD) age of the study population was 71.4+/-9 years. The EOA was evaluated, both by the CE and by the EFVR. A significant linear correlation between the CE and the EFVR was found (r=0.80; P<0.0001). The receiver operating characteristic curve analysis showed good agreement between the CE and the EFVR. An EFVR value of 1.15 or less was found to have a good sensitivity (89%) and good specificity (91%) in identifying patients with an EOA of 1.0 cm2 or smaller, with positive and negative predictive values of 79% and 95%, respectively. The EFVR, a simple index that is less time-consuming than the CE, allows the identification of patients with aortic bioprosthesis stenosis with excellent sensitivity and specificity. It may be taken into consideration in clinical practice for the evaluation of patients with aortic bioprosthesis stenosis and left ventricular dysfunction.

Sixty-Four Slice CT Evaluation of Aortic Stenosis Using Planimetry of the Aortic Valve Area

The purpose of our study was to evaluate planimetry of the aortic valve area with 64-slice CT in comparison with transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in patients with aortic stenosis. Thirty-six patients with aortic valve disease referred for coronary 64-slice CT angiography were examined. Planimetry of the aortic valve area with 64-slice CT was compared with TTE using the Doppler continuity equation for calculation of the aortic valve area and with planimetric measurement of the aortic valve area using TEE. Planimetry of the aortic valve area with CT (1.11 +/- 0.42 cm2) showed a good correlation with TTE (1.05 +/- 0.42 cm2) (r = 0.88, p < 0.001) in 32 patients and a good correlation with TEE (1.41 +/- 1.61 cm2) (r = 0.99, p < 0.0001) in 10 patients. The mean and maximum transvalvular pressure gradients were correlated with the aortic valve area as measured with CT (r = -0.68, p = 0.0001; and r = -0.67, p = 0.0001, respectively). Beta-blockers were not given (mean heart rate, 62.5 +/- 10.7 beats per minute). MDCT allows accurate planimetry of the aortic valve area in patients with aortic stenosis. In patients referred for 64-slice CT coronary angiography, concomitant aortic stenosis can be identified and evaluated.

A comparison of echocardiographic and electron beam computed tomographic assessment of aortic valve area in patients with valvular aortic stenosis

The purpose of this study was to compare electron beam computed tomography (EBT) with transthoracic echocardiography (TTE) in determining aortic valve area (AVA). Thirty patients (9 females, 21 males) underwent a contrast-enhanced EBT scan (e-Speed, GE, San Francisco, CA, USA) and TTE within 17 ± 12 days. In end-inspiratory breath hold, a prospectively ecg-triggered scan was acquired with a beam speed of 50–100 ms, a collimation of 2 × 1.5 mm and an increment of 3.0 mm. The AVA was measured with planimetry. A complete TTE study was performed in all patients, and the AVA was computed using the continuity equation. There was close correlation between AVA measured with EBT and AVA assessed with TTE (r = 0.60, P < 0.01). The AVA measured with EBT was 0.51 ± 0.46 cm2 larger than the AVA calculated with TTE measurements. EBT appeared to be a valuable non-invasive method to measure the AVA. EBT measures the anatomical AVA, while with TTE the functional AVA is calculated, which explains the difference in results between the methods.

Which method should be the reference method to evaluate the severity of rheumatic mitral stenosis? Gorlin's method versus 3D-echo

Several studies have shown a wide variability among different methods to determine the valve area in patients with rheumatic mitral stenosis. Our aim was to evaluate if 3D-echo planimetry is more accurate than the Gorlin method to measure the valve area. Twenty-six patients with mitral stenosis underwent 2D and 3D-echo echocardiographic examinations and catheterization. Valve area was estimated by different methods. A median value of the mitral valve area, obtained from the measurements of three classical non-invasive methods (2D planimetry, pressure half-time and PISA method), was used as the reference method and it was compared with 3D-echo planimetry and Gorlin's method. Our results showed that the accuracy of 3D-echo planimetry is superior to the accuracy of the Gorlin method for the assessment of mitral valve area. We should keep in mind the fact that 3D-echo planimetry may be a better reference method than the Gorlin method to assess the severity of rheumatic mitral stenosis.

Comparison of Proximal Isovelocity Surface Area Method and Pressure Half Time Method for Evaluation of Mitral Valve Area in Patients Undergoing Balloon Mitral Valvotomy

The pressure half time (PHT) method is unreliable for measurement of mitral valve area (MVA) immediately after valvotomy. The proximal isovelocity surface area (PISA) method has been used to derive mitral valve area in patients with mitral stenosis. The aim of our study was to compare PISA method and PHT method in patients undergoing percutaneous balloon mitral valvotomy (BMV). The PISA was recorded from the apex and MVA was calculated using continuity equation by the formula 2pir(2) Vr/Vm, where 2pir(2) is the hemispheric isovelocity area, Vr is the velocity at the radial distance "r" from the orifice, and Vm is the peak velocity. A plain angle correction factor (theta)/180 was used to correct the inlet angle subtended by leaflet tunnel as a result of leaflet doming. MVA calculated using PISA method (r = 0.5217, P < 0.0001, SE = 0.016) and PHT (r = 0.6652, P < 0.0001, SE = 0.017) correlated well with 2D method in patients with mitral stenosis before BMV. After BMV, MVA by PISA method correlated well with 2D planimetry (r = 0.5803, P < 0.0001, SE = 0.053) but PHT showed poor correlation (r = 0.1334, P = 0.199, SE = 0.036). The variability of measurement of MVA was most marked with PHT method in the post-BMV period. The PISA method correlates well with 2D planimetry in patients with mitral stenosis before and after BMV and is superior to the PHT method in the post-BMV period where the latter may be unreliable.

Letter Regarding Article by Rosenhek et al, “Statins but Not Angiotensin-Converting Enzyme Inhibitors Delay Progression of Aortic Stenosis”

To the Editor: We read with interest the study by Rosenhek et al1 demonstrating a lower rate of aortic valve disease progression as indicated by Doppler echocardiographic jet velocity or valve area in patients treated with a statin but not with an angiotensin-converting enzyme (ACE) inhibitor. The authors also found that of 211 patients, 102 were receiving established treatment with ACE inhibitors. As was observed in the accompanying editorial,2 this study adds to existing published evidence that the risk of giving ACE inhibitors to patients with aortic stenosis is largely theoretical.3,4 The idea that these drugs will cause severe hypotension as a result of vasodilatation in the face of fixed left ventricular (LV) outflow obstruction appears to be either incorrect or at least describes a rare event. There are no published reports of severe hypotension or other adverse effects.3 Although ACE inhibitors do …

Does chronic mitral regurgitation influence Doppler pressure half-time-derived calculation of the mitral valve area in patients with mitral stenosis?

Does chronic mitral regurgitation influence Doppler pressure half-time-derived calculation of the mitral valve area in patients with mitral stenosis?

Does chronic mitral regurgitation influence Doppler pressure half-time–derived calculation of the mitral valve area in patients with mitral stenosis?

Background In patients with mitral stenosis (MS), Doppler pressure half-time (PHT) may be influenced by hemodynamic variables other than the anatomic mitral valve orifice narrowing. This study was undertaken to assess whether the presence of concomitant mitral regurgitation (MR) affects mitral valve area (MVA) estimation by PHT. Methods Consecutive patients (n = 166) with noncalcific MS, in sinus rhythm, were studied. Group 1 (n = 106) had no or mild MR, and group 2 (n = 60) had moderate or severe MR. MVA was assessed by using the PHT method and planimetry. Results There was a strong correlation between planimetry and PHT MVA in both groups (group 1: r = 0.86, P < .001; group 2: r = 0.73, P < .001). However, compared with planimetry MVA, PHT underestimated MVA by ≥20% in 18 patients (17%) in group 1 and 21 patients (35%) in group 2 ( P < .01). Overestimation by ≥20% occurred in 12 patients (11%) in group 1 and in 7 (12%) in group 2. Group 2 subanalysis (group 2A: moderate MR, n = 16; group 2B: severe MR, n = 44) revealed that linear regression weakened with increasing severity of MR (group 2A: r = 0.824, P < .001, group 2B: r = 0.70, P < .001). PHT underestimation of MVA occurred in 31% and 36% of patients in Groups IIA and IIB, respectively ( P = NS). Conclusions PHT appears to be reliable for estimating MVA in most patients with MS, even in the presence of MR. However, the presence of significant MR reduces the reliability of PHT-derived MVA, with underestimation of MVA in a significant number of subjects. The severity of MR has a direct impact on PHT-derived MVA.

Clinical Applicability for the Assessment of the Valvular Mitral Stenosis Severity with Doppler Echocardiography and the Proximal Isovelocity Surface Area (PISA) Method

Evaluation of the severity of valvular mitral stenosis and measurements of the effective rheumatic mitral valve area by noninvasive echocardiography has been well accepted. The area is measured by the two-dimensional planimetry (PLM) method and the Doppler pressure half-time (PHT) method. Recently, the proximal isovelocity surface area (PISA) by color Doppler technique has been used as a quantitative measurement for valvular heart disease. However, this method needs more validation. The aim of this study was therefore to investigate the clinical applicability of the PISA method in the measurements of effective mitral valve area in patients with rheumatic valvular heart disease. Forty-seven patients aged from 23 to 71 years, with a mean age of 53 +/- 13 (25 male and 22 female, 15 with sinus rhythm, mean heart rate of 83 +/- 14 beats per minute, with rheumatic valvular mitral stenosis without hemodynamically significant mitral regurgitation) were included in the study. Effective mitral valve area (MVA) derived by the PISA method was calculated as follows: 2 x Pi x (proximal aliasing color zone radius)2x aliasing velocity/peak velocity across mitral orifice. Effective mitral valve areas measured by three different methods (PLM, PHT, and PISA) were compared and correlated with those calculated by the "gold standard" invasive Gorlin's formula. The MVA derived from PHT, PLM, PISA and Gorlin's formula were 1.00 +/- 0.31cm2, 0.99 +/- 0.30 cm2, 0.95 +/- 0.30 cm2 and 0.91 +/- 0.29 cm2, respectively. The correlation coefficients (r value) between PHT, PLM, PISA, and Gorlin's formula, respectively, were 0.66 (P = 0.032, SEE = 0.64), 0.67 (P = 0.25, SEE = 0.72) and 0.80 (P = 0.002, SEE = 0.53). In conclusion, the PISA method is useful clinically in the measurement of effective mitral valve area in patients with rheumatic mitral valve stenosis. The technique is relatively simple, highly feasible and accurate when compared with the PHT, PLM, and Gorlin's formula. Therefore, this method could be a promising supplement to methods already in use.

Comparison of proximal isovelocity surface area method with pressure half time method for evaluation of mitral valve area in patients undergoing balloon mitral valvuloplasty

Comparison of proximal isovelocity surface area method with pressure half time method for evaluation of mitral valve area in patients undergoing balloon mitral valvuloplasty

Association of coronary risk factors with progression of valvular aortic stenosis in older persons

timation” of catheter gradients by Doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery. J Am Coll Cardiol 1999;33:1655–1661. 6. Gardin JM, Henry WL, Savage DD, Ware JH, Burn C, Borer JS. Echocardiographic measurements in normal subjects: evaluation of an adult population without clinically apparent heart disease. J Clin Ultrasound 1979;7:439–447. 7. Drexler M, Erkel R, Muller U, Wittlich N, Mohr-Kahaly S, Meyer J. Measurement of intracardiac dimensions and structures in normal subjects by transesophageal echocardiography. Am J Cardiol 1990;65:1491–1496. 8. Skjaerpe T, Hegrenaes L, Hatte L. Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circualtion1985;72:810–818. 9. Perry GJ, Helineke F, Nanda NC, Byard C, Soto B. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol 1987;9:952–959. 10. Pasipoularides A, Murgo JP, Bird JJ, Craig WE. Fluid dynamics of aortic stenosis: mechanisms for the presence of subvalvular pressure gradients. Am J Physiol1984;246:H542–H550. 11. Connolly HM, Oh JK, Schaff HV, Roger VL, Osborn SL, Hodge DO, Tajik AJ. Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction. Result of aortic valve replacement in 52 patients. Circulation 2000;101:1940–1946.

Intraoperative in situ measurement of aortic valve area in patients with aortic stenosis: A comparison with echocardiographically derived variables Roland R. Brandt, Manfred Jung, Erwin P. Bauer, Hassan Bahavar, Christian W. Hamm. Kerckhoff Heart Center, Bad Nauheim, Germany

Intraoperative in situ measurement of aortic valve area in patients with aortic stenosis: A comparison with echocardiographically derived variables Roland R. Brandt, Manfred Jung, Erwin P. Bauer, Hassan Bahavar, Christian W. Hamm. Kerckhoff Heart Center, Bad Nauheim, Germany

Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography

OBJECTIVESThis study was performed to determine the feasibility, accuracy and reproducibility of real-time volumetric three-dimensional echocardiography (3-D echo) for the estimation of mitral valve area in patients with mitral valve stenosis.BACKGROUNDPlanimetry of the mitral valve area (MVA) by two-dimensional echocardiography (2-D echo) requires a favorable parasternal acoustic window and depends on operator skill. Transthoracic volumetric 3-D echo allows reconstruction of multiple 2-D planes in any desired orientation and is not limited to parasternal acquisition, and could thus enhance the accuracy and feasibility of calculating MVA.METHODSIn 48 patients with mitral stenosis (40 women; mean age 61 ± 13 years) MVA was determined by planimetry using volumetric 3-D echo and compared with measurements obtained by 2-D echo and Doppler pressure half-time (PHT). All measurements were performed by two independent observers. Volumetric data were acquired from an apical view.RESULTSAlthough 2-D echo allowed planimetry of the mitral valve in 43 of 48 patients (89%), calculation of the MVA was possible in all patients when 3-D echo was used. Mitral valve area by 3-D echo correlated well with MVA by 2-D echo (r = 0.93, mean difference, 0.09 ± 0.14 cm2) and by PHT (r = 0.87, mean difference, 0.16 ± 0.19 cm2). Interobserver variability was significantly less for 3-D echo than for 2-D echo (SD 0.08cm2 versus SD 0.23cm2, p < 0.001). Furthermore, it was much easier and faster to define the image plane with the smallest orifice area when 3-D echo was used.CONCLUSIONSTransthoracic real-time volumetric 3-D echo provides accurate and highly reproducible measurements of mitral valve area and can easily be performed from an apical approach.

Validation of the ejection fraction-velocity ratio: a new simplified “function-corrected” index for assessing aortic stenosis severity

A new echocardiographic method for the evaluation of aortic stenosis (AS) severity has recently been introduced: the fractional shortening-velocity ratio (FSVR = fractional shortening/4 Vmax2). An important advantage of the method is the possibility of avoiding the difficulties related to the measurement of left ventricular outflow tract in calcific AS for assessing the continuity equation. FSVR, however, also shows some significant limitations especially in patients with regional wall motion abnormalities and conduction defects. To overcome this problem, we developed a new index: the ejection fraction-velocity ratio (EFVR = ejection fraction/4 Vmax2), where percent ejection fraction and Vmax have been obtained with an apical echocardiographic approach. In 343 consecutive patients with AS, aortic valve area was measured by cardiac catheterization (Gorlin), whereas FSVR and EFVR were calculated by echo-Doppler examination performed within 24 hours. Mean valve area was 0.70 ± 0.30 cm2, mean EFVR was 0.78 ± 0.41, and mean FSVR was 0.45 ± 0.26. The linear correlation area-EFVR was highly significant (r = 0.88). Correlation valve area-FSVR was also significant (r = 0.82). EFVR allowed identification of patients with severe AS (area ≤0.8 cm2) with good sensitivity (88%) and specificity (85%), whereas FSVR demonstrated sensitivity of 88% and specificity of 73%. Thus, the EFVR, a very simple and not time-consuming index, is strongly related to aortic valve area in patients with AS. It allows identification of patients with severe AS with good sensitivity and specificity (better than FSVR). The EFVR, taking into consideration both ejection fraction and transvalvular pressure gradient, may be very useful in the evaluation of patients with AS and left ventricular dysfunction.

480 Reproducibility of estimation of miral valve area in patients with mitral stenosis by the flow convergence region method

480 Reproducibility of estimation of miral valve area in patients with mitral stenosis by the flow convergence region method

Follow-Up Assessment after Percutaneous Mitral Valvuloplasty (PMV) with Inoue Balloon

Background:Percutaneous Mitral Valvuloplasty (PMV) is the first-line treatment modality in selected patients with symptomatic mitral stenosis and more recently available Inoue single-balloon catheter technique produces good results with low incidence of complications. The purpose of this study was to evaluate the immediate and over 6 months follow-up results after successful PMV with an Inoue balloon and to identify the predictive factors for the results. Methods:From May 1995 to Feburary 1997, a PMV with an Inoue balloon was technically successful in 114 (95%) of the 119 patients treated at the Sejong General Hostpital. In this study, a series of echocardiographic follow-up were performed in 54 patients with rheumatic mitral stenosis, at least 6 months after their successful PMV. In PMV, the inflation was conducted in steps, starting with a recommended maximum size of balloon by the Inoue criteria. After each inflation, the mitral valve opening and competence were evaluated by Transesophageal echocardiography (TEE) and continuing increase balloon size. Results:Echocardiographic follow-up assessment was performed in 54 patients serially in a interval of 3 months or 6 months. Their mean age was 46±11 years (24 to 66 years) and the mean total echocardiographic score was 7.1±1.6. A optimal result was obtained in 95% of the cases (51/54). The post-PMV mitral valve area increased to 1.95±0.37 cm and 1.79± 0.28 cm by 2-D and Doppler method, the average transmitral mean diastolic pressure gradient decreased to 5.16±2.8 mmHg and LA pressure was decreased to 11.28±8.2 mmHg. The newly developed and aggravated mitral regurgitation was observed in 17 patients (31.5%). The restenosis was noted in 2 cases (3.7%) after 1 year follow-up. The pre-procedural echocardiographic score for leaflet mobility, thickening and calcification was more higher in patients with restenosis. There was significant tendency of decrement in the mitral valve area in patients with a echocardiographic score>8 compared with those≤8 over 6 months after the PMV. Conclusion: PMV with the Inoue balloon under TEE guide as a combined treatment modality of patient with symptomatic mitral stenosis is relatively safe and achieves good immediate and midterm follow-up results. The echocardiographic score is considered as useful predictor of midterm results and restenosis after PMV with Inoue balloon. (Korean Circulation J 1998;28(11):1841-1851)