Uso de la valvuloplastia mitral percutánea con balón en un hospital provincial / Use of the mitral percutaneous balloon valvuloplasty in a provincial hospital

Se realizó un estudio observacional y descriptivo, que incluyó a 46 pacientes tratados con valvuloplastia mitral percutánea con balón, en el Hospital Provincial Saturnino Lora Torres de Santiago de Cuba, desde julio de 2008 hasta diciembre de 2015, a fin de evaluar el resultado inmediato del proceder empleado. Se analizaron variables clinicoepidemiológicas, ecocardiográficas y hemodinámicas. Predominaron los pacientes jóvenes de 15-44 años (63,0 por ciento), las mujeres con antecedentes de fiebre reumática (87,0 por ciento), la clase III, según la clasificación funcional de la insuficiencia cardiaca (76,1 por ciento) y el ritmo sinusal (84,8 por ciento). Se logró un aumento del área valvular superior a 100,0 por ciento y una reducción de la presión auricular de aproximadamente 50,0 por ciento. El tratamiento fue satisfactorio en 93,5 por ciento de los afectados. Hubo asociación significativa entre los pacientes con una escala de Wilkins de 8 o menos y el sexo femenino, con un resultado favorable de dicho proceder

An observational and descriptive study that included 46 patients treated with mitral percutaneous balloon valvuloplasty, was carried out in Saturnino Lora Torres Provincial Hospital in Santiago de Cuba, from July, 2008 to December, 2015, in order to evaluate the immediate result of the procedure that was used. Clinical epidemiological, echocardiographic and hemodynamic variables were analyzed. There was a prevalence of the young patients aged 15-44 (63.0 percent), women with history of rheumatic fever (87.0 percent), the class III, according to the functional classification of heart failure (76.1 percent) and the sinus rhythm (84.8 percent). A 100.0 percent increase from the upper valvular area and an approximately 50.0 percent reduction of the atrial pressure were achieved. The treatment was satisfactory in 93.5 percent of the affected patients. There was a significant association between the patients with an 8 or less Wilkins scale and the female sex, with a favorable result of the procedure

Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses.

Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease‑as a potentially less invasive method of valve replacement in high‑risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high‑risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high‑risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve‑in‑valve implantation procedure of both aortic and mitral valves.

Valvuloplastía en estenosis mitral moderada a severa por sobre reemplazo valvular, según criterios de Wilkins: reporte de un caso / Valvuloplasty in moderate to severe mitral stenosis over valve replacement, according to Wilkins score: case report

INTRODUCCIÓN: La valvulopatía reumática es una entidad aún frecuente en Chile, siendo la válvula mitral la más afectada. Su principal motivo de consulta es disnea progresiva. Sin tratamiento tiene mal pronóstico debido al estrechamiento progresivo de dicha válvula. En la actualidad es posible tratarla mediante cirugía abierta y valvuloplastía mitral percutánea. En este caso se revisa y discute las indicaciones actualizadas de cada una, destaca al ecocardiograma para la selección de los pacientes, y analiza las ventajas y desventajas de las diferentes técnicas. PRESENTACIÓN DEL CASO: Mujer de 44 años, con estenosis mitral, disnea progresiva en Capacidad Funcional (CF) III de 3 años de evolución. Se realiza ecocardiografía transtorácica que demuestra estenosis mitral severa de etiología reumática y se decide cirugíade reemplazo valvular. En el ecocardiograma transtorácico para evaluación preoperatorio se concluye score de Wilkins de 5 puntos por lo que se sugiere realizar valvuloplastía mitral, resultando exitosa sin complicaciones y con aumento de área mitral a 1,9 cm2. DISCUSIÓN: Inicialmente se planteó cirugía de reemplazo valvular, pero al realizar el ecocardiograma preoperatorio se decide realizar valvuloplastía mitral por sobre cirugía debido al score de Wilkins. Éste score es la herramienta más utilizada para decidir entre estas dos técnicas, y según últimos estudios puede ser mejorado con la inclusión del parámetro de calcificación comisural evitando de esta manera sus principales complicaciones.

INTRODUCTION: Rheumatic valve disease is still common entity in Chile, being mitral valve the most affected. His main complaint is progressive dyspnea. Without treatment has a poor prognosis due to progressive narrowing of the valve. It is now possible to treat by an open surgery or percutaneous mitral valvuloplasty. In this case we review and discuss the indications, highlight the echocardiogram for patient selection, and discusses the advantages and disadvantages of the different techniques. CASE PRESENTATION: 44 years old woman with mitral stenosis, progressive dyspnea Functional Capacity (CF) III of 3 years duration. Transthoracic echocardiography was performed demonstrating severe mitral stenosis of rheumatic etiology and decides valve replacement surgery. In transthoracic echocardiography for preoperative evaluation concludes Wilkins score of 5 points so it is suggested mitral valvuloplasty proving successful and uncomplicated mitral area increased to 1.9 cm2. DISCUSSION: originally was raised valve replacement surgery and because of the preoperative echocardiogram is decided to perform mitral valvuloplasty instead of surgery because of Wilkins score. This score is the most used tool for deciding between these two techniques, and according to recent studies can be improved with the inclusion of commissural calcification parameter thus avoiding its major complications.

Initial experience of using intracardiac echocardiography [ICE] for guiding balloon mitral valvuloplasty [BMV]

BMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram [ICE] guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures. During BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography [TTE], and catheterization derived hemodynamic measurements [cath]. Seventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 +/- 21 years. The mean MV area increased from 0.9 +/- 0.1 cm[2] to 1.7 +/- 0.2 cm[2], P < 0.0001 and the mean gradient decreased from 12.6 +/- 5.8 mmHg to 4.9 +/- 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath. ICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath

Intracardiac ultrasound-guided percutaneous mitral valvuloplasty / Valvuloplastía mitral percutánea guiada por ultrasonido intracardiaco

Intracardiac echocardiography (ICE) is a relatively new method of ultrasound images useful during cardiac percutaneous interventional procedures. The first human experience with this method was published in 2000 and, since then, several original trials have enrolled this useful method, proving similar and more useful than transesophageal echocardiography in percutaneous treatment of several congenital cardiopathies, like interatrial communication, permeable oval foramen, mitral stenosis, and atrial fibrillation ablation. In this presentation, we publish a single case report of percutaneous mitral valvuloplasty under ICE guidance.

La ecocardiografía intracardiaca (EIC) es un método relativamente nuevo de imágenes por ultrasonido que utilizamos principalmente durante procedimientos de cateterismo intervencionista. La primera experiencia en seres humanos con este método fue reportada en 2000 y, desde entonces, se han publicado diversos artículos sobre su utilidad como procedimiento de control sustituto de la ecocardiografía transesofágica, en el tratamiento por cateterismo de la comunicación interatrial, comunicación interventricular, foramen oval permeable, estenosis mitral y ablación de fibrilación auricular. En esta ocasión presentamos un caso de estenosis mitral y valvuloplastía percutánea, guiado por EIC.

Resultados imediatos e tardios da valvoplastia mitral percutânea em pacientes com estenose mitral / Immediate and late results of percutaneous mitral valve repair in patients with mitral stenosis

FUNDAMENTO: A análise dos resultados imediatos e a longo prazo da valvoplastia mitral por catéter-balão (VMCB) ainda são escassos na literatura, principalmente no contexto nacional. OBJETIVO: Avaliar os resultados imediatos e tardios dos pacientes submetidos à VMCB. MÉTODO: 330 pacientes consecutivos foram seguidos por 47 ± 36 meses (até 126 meses). Análises univariadas e multivariadas avaliaram os fatores relacionados ao sucesso do procedimento, à reestenose e aos eventos tardios (morte ou necessidade de nova intervenção na valva mitral). O método de Kaplan-Meier estimou a sobrevida livre de eventos. RESULTADOS: Houve sucesso do procedimento em 305 (92,4 por cento). A anatomia valvar mitral foi o principal preditor de sucesso imediato do procedimento. Durante o seguimento, a reestenose ocorreu em 77 (23,3 por cento) pacientes e esteve associada a menor área valvar mitral e maior calcificação antes do procedimento. Ocorreram 67 eventos em um tempo médio de seguimento de 38 ± 26 meses. A probabilidade de sobrevida livre de eventos foi de 95 por cento em 1 ano, 75 por cento aos 5 anos e 61 por cento aos 10 anos. Os preditores de sobrevida livre de eventos foram: idade, escore ecocardiográfico e resultado imediato do procedimento. CONCLUSÃO: A VMCB é um procedimento efetivo, sendo que mais de 60 por cento dos pacientes estiveram livres de eventos ao final do seguimento. A condição anatômica da valva mitral e a idade do paciente foram os melhores preditores da sobrevida livre de eventos e devem ser levados em consideração na seleção dos pacientes para VMCB.

BACKGROUND: The analysis of immediate and long-term results of mitral valvoplasty by balloon catheter (MVRBC) are still lacking in literature, mainly in the national context. OBJECTIVE: To assess the immediate and late results of patients submitted to mitral valve repair by balloon catheter. METHOD: A total of 330 consecutive patients were followed-up by 47 ± 36 months (up to 126 months). Univariate and multivariate analyses assessed the factors associated with the success of the procedure, restenosis and late events (death or necessity of new intervention on mitral valve). Kaplan-Meier method estimated survival without events. RESULTS: The procedure was successful in 305 cases (92.4 percent). The mitral valve anatomy was the main predictor for immediate success for the procedure. During the procedure, restenosis occurred in 77 (23.3 percent) patients and was associated with smaller mitral valve area and with larger calcification before the process. In a mean period of 38 ± 26-month follow-up, 67 events occurred. The probability of survival without events was of 95 percent in one year, 75 percent in five years and 61 percent in ten years. The predictors of survival without events were: age, echocardiography score and immediate result of the procedure. CONCLUSION: Mitral valve repair by balloon catheter is an effective procedure, as 60 percent patients did not present events after the follow-up. The anatomical condition of the mitral valve and the patient's age were the best predictors of survival without events, and should be taken into account when selecting patients for the mentioned procedure. (Arq Bras Cardiol 2010; 94(3):383-390)

Valvuloplastía mitral percutánea: experiencia del Hospital San Juan de Dios / Percutaneous mitral valvuloplasty: the San Juan de Dios Hospital experience

Objetivo: Evaluar los resultados alejados de la valvuloplastía mitral percutánea (VMP), y analizar los factores asociados con eventos y reestenosis tardía. Métodos y resultados: De 252 VPM realizadas entre diciembre de 1987 y diciembre de 2006, 245 pacientes tuvieron un mínimo de 6 meses de seguimiento y evaluación ecocardiográfica antes y después del procedimiento (97 por ciento). La edad media fue de 46,3 +/- 11,37 años, las mujeres fueron 83,6 por ciento. La media de seguimiento fue de 35,25 +/- 28,84 meses, rango 6-132. La muerte cardiovascular, y el reemplazo de la válvula mitral o una segunda VMP fueron considerados como marcadores de peor resultado. El área de la válvula mitral aumentó de 1,0 +/- 0,17 cm2 a 1,71 +/- 0,31 cm2 (p <0,0001) después del procedimiento. Durante el seguimiento, 53 pacientes (21,6 por ciento) presentaron reestenosis, que fue predicha por un Score de Wilkins > 8 (p = 0,03). Cinco pacientes fallecieron (2,04 por ciento), 22 (8,9 por ciento) requirieron reemplazo de la válvula mitral y 11 (4,5 por ciento) una segunda VMP. No encontramos variables clínicas o ecocardiográficas capaces de predecir estos eventos. Conclusiones La VMP tuvo una tasa aceptable de complicaciones atribuibles al procedimiento. Las características ecocardiográficas de la válvula mitral se correlacionaron con la reestenosis. La incidencia de eventos tardíos es baja.

Objective: To evalúate the long-term results of percutaneous mitral valvuloplasty (PMV), and analyze the factors associated with restenosis and late events. Methods and results: Of 252 PMV performed between December 1987 and December 2006, 245 patients with a minimum of 6 months follow-up and echocardiographic evaluation before and after the procedure, were selected for long-term follow-up (97 percent). The mean age was 46.3 +/- 11.37 years old, 83.6 percent women. The mean follow-up was 35.25 +/- 28.84 months, range 6-132. Cardiovascular death, and mitral valve replacement or second PMV, were considered as markers of worst outcome. The mitral valve area increased from 1.0+/-0.17cm2 to 1.71 +/- 0.31 cm2 (p <0.0001) after the first procedure. During follow up, 53 patients (21.6 percent) developed restenosis, which was predicted by a Wilkins score > 8 (p = 0.03). Five (2.04 percent) patients died. Twenty-two (8.9 percent) required mitral valve replacement and 11(4.5 percent) a second PMV. We found that no clinical or echocardiographic variables were able to predict these events. Conclusions: PMV had an acceptable rate of complications attributable to the procedure. The echocardiographic characteristics of the mitral valve correlated with restenosis. The incidence of late events is low.

Implante de marcapasso definitivo em gestante portadora de valvopatia mitral reumática / Permanent pacemaker implantation in a pregnant woman with rheumatic mitral valve disease / Implante de marcapaso definitivo en gestante portadora de valvulopatía mitral reumática

Descrevemos um caso raro de implante de marcapasso definitivo em gestante, portadora de valvopatia mitral reumática, previamente submetida à valvoplastia percutânea por cateter-balão. A paciente apresentava bloqueio atrioventricular de grau avançado, de causa não-reversível, sintomático e manifesto no 3º trimestre da gestação.

We describe a rare case of permanent pacemaker implantation in a pregnant woman with rheumatic mitral valve disease previously undergoing percutaneous balloon valvuloplasty. She presented symptomatic advanced atrioventricular block of non-reversible cause and manifest in the third trimester of gestation.

Describimos un caso raro de implante de marcapaso definitivo en gestante, portadora de valvulopatía mitral reumática, previamente sometida a valvuloplastia percutánea por catéter balón La paciente presentaba bloqueo atrioventricular en grado avanzado, de causa irreversible, sintomático y manifiesto en el 3º trimestre de gestación.

Early and short term postoperative outcome of mitral valve replacement in patients with rheumatic mitral valve disease at Assiut University Hospitals

Rheumatic heart disease and its consequent valvular lesions is a major health problem in Egypt. Mitral valve replacement [MVR] is a routine procedure in cardiac surgery with considerable benefits in terms of postoperative quality of life and survival. To assess early [30days] and short term [3-6 months] outcome of patients with mitral valve disease undergoing MVR in our locality. This study was conducted on 72 patients [46 women and 26 men, with mean age of 28.2 +/- 12 years] with rheumatic mitral valve disease underwent MVR at Assiut University Hospital from January 2005 to May 2007. Preoperative, operative, and postoperative data were prospectively collected and analyzed as regards structural and hemodynamic outcome using echocardiography with its all modalities. Also, postoperative morbidity and mortality were determined. Fifteen post-operative morbidity occurred in 12 patients [16.6%], 10 occurred early [<30 days] and 5 late [>30 days]. Early post-operative morbidity occurred due to non-valve related causes in 60% of cases as acute heart failure, cardiogenic shock and electrolyte disturbances, and in 40% of cases due to valve related causes as prosthetic valve thrombosis, early prosthetic valve endocarditis and periprosthetic valve leakage. All late post-operative morbidity were caused by valve-related causes as late prosthetic valve endocarditis, prosthetic valve thrombosis and periprosthetic valve leakage. The 30-day hospital mortality was 6.9% [n=5], 60% of deaths were due to non-valve related causes, and 40% with valve related causes were identified as independent risk factors. Late postoperative mortality occurred in 2.8% [n=2] and all of them were due to valve related causes. Mitral valve replacement for patients with rheumatic mitral valve disease offers I satisfactory early and short-term results with excellent symptomatic improvement. Our institutional surgical results are comparable to the international results regarding postoperative morbidity and mortality

Papel do tratamento farmacológico na evolução e nas complicações das valvopatias mitrais / Pharmacological management influence on the natural history and complications of mitral disease

As valvulopatias mitrais de etiologia reumática ainda são muito prevalentes em nosso meio...

Quando intervir no paciente assintomático com valvopatia mitral? / Asymptomatic patient with mitral valvopaty. When submit patient to mitral intervention?

O momento ideal para indicação cirúrgica ou percutânea nos pacientes assintomáticos com valvopatia mitral tem sido motivo de várias discussões...

Abordagem cirúrgica das valvopatias mitrais: o que há de novo? / Surgical approach of mitral valve disease: what's new?

Após um período inicial conturbado e de lenta progressão sobre a valva mitral vêm recebendo acelerado desenvolvimento no que se refere a procedimentos...

Valvoplastia mitral percutânea complicada com tamponamento cardíaco em paciente gestante / Percutaneous mitral valvuloplasty complicated by cardiac tamponade in a pregnant patient

A ocorrência de Hemopericárdio com Tamponamento Cardíaco é uma complicação da Valvoplastia Mitral Percutânea por balão (VMB), que apesar de pouco freqüente, pode ter graves conseqüências materno-fetais. Este artigo descreve o caso de um tamponamento cardíaco após VMB em uma mulher de 28 anos, com estenose mitral reumática severa na 20ª semana de gravidez.

The occurrence of hemopericardium with cardiac tamponade is a complication of percutaneous balloon mitral valvuloplasty (BMV) which, although uncommon, may have severe maternal and fetal consequences. This article describes a case of cardiac tamponade following BMV in a 28-year-old woman with severe rheumatic mitral stenosis in the 20th week of gestation.

Experience of percutaneous mechanical mitral commissurotomy using metallic commissurotome in patients with mitral stenosis at chest disease institute.

BACKGROUND: Percutaneous metallic mitral commissurotomy (PMMC) has been accepted as an alternative to the traditional balloon technique. The advantage of the metallic commissurotome is that it is designed for several reuse and resterization and it is an interesting tool as seen by the authors. OBJECTIVE: To evaluate the efficacy and safety of PMMC among a wide range of patients with severe mitral stenosis. MATERIAL AND METHOD: Between July 2000 and August 2003, patients with severe mitral stenosis who underwent PMMC were enrolled Interatrial septum was punctured under transesophageal echocardiography guidance in all cases. Demographic data and baseline characteristics were collected Mitral valve area (MVA) was evaluated by echocardiography and hemodynamic parameters pre and post PMMC were compared RESULTS: PMMC was performed in 304 patients with a broad range of severe mitral stenosis. Mean age was 38.7 +/- 10. 9 years and 79% was female. Most were in functional class 11 (94%) and 43 patients (14%) had prior commissurotomy. Atrial fibrillation was found in 41%. Twenty-six patients were crossed over to the Inoue balloon technique. The rate of success was 81% in all patients (246/304) and 89% in patients when PMMC was actually done (246/278). The MVA increased from 84 +/- 22 to 170 +/- 36 mm2 (p < 0.0001). Transvalvular gradient decreased from 17 +/- 6 to 7 +/- 4 mmHg (p < 0.0001) and mean left atrial pressure from 26 +/- 7 to 15 +/- 6 mmHg (p < 0.0001). Separation of both commissures was found in 25% and 61% had symptom relief by a reduction in functional class at least one level (p < 0.0001). Complications developed in 16 patients (5.3%) including three serious events, one death caused by severe mitral regurgitation followed by emergency surgery, another survivor after surgical repair of left ventricular free wall rupture and the last one with surgical removal of the malfunctioned device stuck in the left atrium. CONCLUSION: Results of PMMC is not as encouraging as shown in previous studies. The risk of cardiac tamponade is minimized by interatrial septal puncture using transesophageal echocardiography (TEE) monitoring but this technique increased the possibility of crossover. Deterioration of the metallic commissurotome after a few procedures is demonstrated in the author's real practice.

Repeat percutaneous mitral valvuloplasty [PMV] in patients with restenosis following to previous PMV

Symptomatic mitral restenosis developed in 4% to 39% of patients after PMV. It is unknown that these patients may benefit from repeat percutaneous mitral valvuloplasty [PMV]. This study assesses the immediate and early outcomes of redo PMV in patients with restenosis after prior PMV. Our study report the immediate and early outcome of 54 patients [mean age 38 +/- K2 years, 14 women and 40 male] with symptomatic mitral restenosis after prior PMV, who were treated with a repeat PMV at 3.8+2.4 years after the initial PMV. After the procedure there was a substantial increase in mitral valve area [MVA] from 1.0 + 0.2 to2.2 +/- 0.4 cm [p<0.001] and a decrease in left atrial pressure from 27+8 to 15 +/- 6mm Hg [p<0.001] and in mitral valve gradient from 17+4 to 2+1 mm Hg [P <0.001]. Mean pulmonary artery pressure did not change significantly with redo-PMV. No patient developed severe mitral regurgitation [3+] after redo PMV. Successful procedural outcome [post-PMV mitral valve area>=l .5 cm[2], pulmonary /systemic flow ratio=

Percutaneous balloon valvotomy for combined rheumatic mitral and aortic stenosis

Balloon dilatation of the mitral valve is an established modality of treating patients with mitral stenosis. However, there is limited experience for simultaneous dilatation of combined mitral and aortic stenosis report our experience in percutaneous balloon valvotomy for combined mitral and aortic rheumatic stenosis. we describe a case of a 33 years old woman who successfully balloon valvotomy for rheumatic mitral and aortic stenosis via the transseptal anterog ade approach using Inoue balloon for mitral valve and retrograde approach single balloon for aortic valve. Double valve balloon valvotomy is feasible and safe in selected patients with combined mitral and aortic rheumatic stenosis

Comparação da evolução a longo prazo da valvoplastia mitral percutânea por balão com a técnica de inoue versus a do balão único: análise dos fatores de risco para óbito e eventos maiores / Comparison of the inoue and single balloon techniques during long term percutaneous balloon mitral valvoplasty follow-up: analysis of risk factors for death and major events

OBJETIVO: Analisar a evolução a longo prazo de pacientes submetidos a valvoplastia mitral percutânea por balão com a técnica do balão de Inoue versus a técnica do balão único Balt, identificando os fatores que predisseram óbito e eventos maiores (óbito, nova valvoplastia mitral por balão ou cirurgia valvar mitral). MÉTODOS: O período de seguimento, nos grupos do balão único e do balão de Inoue, foi de 54 ± 31 (1 a 126) meses e de 34 ± 26 (2 a 105) meses, respectivamente (p < 0,0001). O balão único Balt foi usado em 254 (84,1 por cento) pacientes e o balão de Inoue, em 48 (15,9 por cento). RESULTADOS: Foram encontrados os seguintes dados, respectivamente, no grupo do balão de Inoue e do balão único: idade, 36,9 ± 10,4 (19 a 63) anos e 38,0 ± 12,6 (13 a 83) anos (p = 0,5769); escore ecocardiográfico, 7,5 ± 1,3 pontos e 7,2 ± 1,5 pontos (p = 0,1307); sexo feminino, 72,9 por cento e 87,4 por cento (p = 0,0097); fibrilação atrial, 10,4 por cento e 16,1 por cento (p = 0,4275); mortalidade no seguimento, 2,1 por cento e 4,3 por cento (0,6984); e eventos maiores, 8,3 por cento e 17,7 por cento (p = 0,1642). Não houve, na análise univariada e nas curvas de Kaplan-Meier, diferença entre as técnicas de Inoue e do balão único Balt para sobrevida e sobrevida livre de eventos maiores. Na análise multivariada, idade > 50 anos e escore ecocardiográfico > 8 predisseram, independentemente, óbito, e escore ecocardiográfico > 8 e área valvar mitral pós-procedimento < 1,50 cm² predisseram eventos maiores. CONCLUSÃO: Não houve diferença na evolução a longo prazo dos pacientes submetidos a técnica de Inoue versus a do balão único. Predisseram óbito e/ou eventos maiores: idade > 50 anos, escore ecocardiográfico > 8 e área valvar mitral pós-procedimento < 1,50 cm².

OBJECTIVE: To analyze the long term evolution of patients undergoing percutaneous balloon mitral valvoplasty comparing the Inoue and Balt single balloon methods, and to identify predictors of death and major events (death, repeat balloon mitral valvoplasty or mitral valve surgery). METHODS: The follow-up for the single and Inoue balloon groups were 54 ± 31 (1 to 126) months and 34 ± 26 (2 to 105) months, respectively (p < 0.0001). The Balt single balloon was used in 254 (84.1 percent) patients and the Inoue balloon in 48 (15.9 percent). RESULTS: The following data were found for the Inoue and single balloon groups, respectively: age, 36.9 ± 10.4 (19 to 63) years and 38.0 ± 12.6 (13 to 83) years (p = 0.5769); echocardiographic score, 7.5 ± 1.3 points and 7.2 ± 1.5 points (p = 0.1307); female gender, 72.9 percent and 87.4 percent (p = 0.0097); atrial fibrillation, 10.4 percent and 16.1 percent (p = 0.4275); mortality during follow-up, 2.1 percent and 4.3 percent (0.6984); and major events, 8.3 percent and 17.7 percent (p = 0.1642). Univariate and Kaplan-Meier curve analyses revealed no differences between the Inoue and Balt single balloon techniques in relation to survival and major event free survival. In the multivariate analysis, age > 50 years and an echocardiographic score > 8 were independent predictors of death; and an echocardiographic score > 8 and post operative mitral valve area < 1.50 cm² were predictors for major events. CONCLUSION: No differences were found in the long term evolution of patients undergoing the Inoue versus the single balloon technique. Predictors of death and/or major events were: age > 50 years, echocardiographic score > 8 and mitral valve area < 1.50 cm² after the procedure.

Valvoplastia mitral percutânea em paciente gestante guiada apenas pelo ecocardiograma transesofágico / Percutaneous mitral valvuloplastry in a pregnant woman guided only by the transesophageal echocardiography

A estenose da válvula mitral é a lesão de válvula mais comum durante a gravidez. Apesar de um tratamento clínico eficaz e de uma anatomia valvular favorável, de acordo com o critério de Wilkins e Block [score de Wilkins-Block], a intervenção percutânea em pacientes sintomáticas mostra-se muito importante. Nessas pacientes, recomenda-se evitar ao máximo a exposição aos raios X para proteger o feto dos efeitos deletérios da radiação ionizante. Neste relato de caso, uma paciente de 24 anos, grávida, com grave estenose mitral (área valvular de 0,9 cm²), foi submetida com sucesso a um tratamento percutâneo com ETE-guiado, sem o uso de raios X.

Mitral valve stenosis is the most common valve lesion in pregnancy. In spite of an optimized clinical treatment and a favorable valve anatomy according to Wilkins and Block score, in symptomatic patients, percutaneous intervention is shown to be of great importance. In these patients, avoiding x-ray exposure as much as possible is recommended so as to protect the fetus from the deleterious effects of ionizing radiation. In this case report, a 24-year old pregnant patient with severe mitral stenosis (valve area of 0.9 cm²) was successfully submitted to a TEE-guided percutaneous treatment, without the use of x-ray.