ABSTRACT
Percutaneous mitral balloon valvuloplasty [MBV] was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, MBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis [MS]. With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. When the reported complications of MBV are viewed in aggregate, complications occur at approximately the following rates: mortality [0-0.5%], cerebral accident [1-2%], mitral regurgitation [MR] requiring surgery [1.6-3%]. These complication rates compare favorably to those reported after surgical commissurotomy. Several randomized trials reported similar hemodynamic results with MBV and surgical commissurotomy. Restenosis after MBV ranges from 4% to 70% depending on the patient selection, valve morphology, and duration of follow-up. Restenosis was encountered in 31% of the author's series at mean follow-up 9 +/- 5.2 years [range 1.5-19 years] and the 10, 15, and 19 years restenosis-free survival rates were [78 +/- 2%] [52 +/- 3%] and [26 +/- 4%], respectively, and were significantly higher for patients with favorable mitral morphology [MES = 8] at 88 +/- 2%, 67 +/- 4%and 40 +/- 6%], respectively [P<0.0001]. The 10, 15, and 19 years event-free survival rates were [88 +/- 2%, 60 +/- 4%and 28 +/- 7%, respectively, and were significantly higher for patients with favorable mitral morphology [92 +/- 2%, 70 +/- 4%and 42 +/- 7%, respectively [P<0.0001]. The effect of MBV on severe pulmonary hypertension, concomitant severe tricuspid regurgitation, left ventricular function, left atrial size, and atrial fibrillation are addressed in this review. In addition, the application of MBV in specific clinical situations such as in children, during pregnancy and for restenosis is discussed
Subject(s)
Humans , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Mitral Valve Insufficiency/surgeryABSTRACT
Long-term echocardiographic follow-up studies of mitral balloon valvuloplasty [MBV] are scarce. The study aim was to assess the long-term results [up to 18 years] of MBV and to identify predictors of restenosis and event-free survival. The immediate and long-term clinical and echocardiographic results for 531 consecutive patients [mean age 31 +/- 11 years] who underwent successful MBV for severe mitral stenosis [MS] and were followed up for a mean of 8.5 +/- 4.8 years [range: 1 .5 to 18 years] after MBV are reported. Immediately after MBV, the mitral valve area [MVA] was increased from 0.92 +/- 0.17 cm[2] to 1.95 +/- 0.29 cm[2] [p< 0.0001]. Restenosis occurred in 165 patients [31%], and was less frequent [19%] in patients with a low mitral echo score [MES - 8]. Actuarial freedom from restenosis at 10, 15 and 18 years was 77 +/- 2%, 46 +/- 3% and 18 +/- 4%, respectively, and was significantly higher in patients with MES - 8 [86 +/- 2%, 62 +/- 4% and 31 +/- 7%] than in those with MES > 8 [p< 0.001]. Event-free survival [death, redo MBV, mitral valve replacement, NYHA class III or IV] at 10, 15 and 18 years was 88 +/- 1%, 53 +/- 4%, and 21 +/- 5% respectively, and was significantly higher for patients with MES - 8 [93 +/- 2%, 65 +/- 5% and 38 +/- 8%, respectively; p< 0.001]. Multivariable Cox regression analysis identified MES>8 [p< 0.0001] and previous surgery [p= 0.043] as predictors of restenosis, and MES >8 [p< 0.0001] and baseline atrial fibrillation [p=0.03] as predictors of combined events. MBV provides excellent long-term results for selected patients with MS. The long-term outcome of this procedure can be predicted from the baseline clinical and echocardiographic characteristics of the mitral valve