Echocardiographic factors determining immediate result of percutaneous mitral balloon commissurotomy

ABSTRACT

Define echocardiographie predictors of the result after percutaneous mitral balloon commissurotomy [PMC]. PMC by the Inoue balloon was attempted in 247 patients -[77% female] with severe mitral valve stenosis. The mean age was 35 years. All the patients had undergone echocardiographie examination before PMC to assess mitral anatomy, commissural calcification, and to determine the Wilkins score. The mean value of Wilkins score was 7,98 +/- 1,61 [range 5-13] and the mean mitral valve area [MVA] before PMC was 1 +/- 0,19 cm2 [range 0,5- 1,4 cm2]. 29 patients [11,7%] had one-commissural calcification and 2 patients [0,8%] had bi-commissural calcifications. After PMC, the mean MVA increased to 1,79 +/- 0,34 cm2 [p <0,001] resulting in a success rate of 83%. Severe mitral regurgitation [>grade 3] occurred in five patients [2%]. Wilkins score was an independent predictor of the immediate result of PMC but, if > 8, this score had a weak predictive value. Commissural morphology was another independent predictor of the immediate result of PMC. Echocardiography is now the cornerstone for the assessment of mitral anatomy before PMC and should integrate Wilkins score and commissural morphology for the selection of patients to PMC