Pathomorphological characteristics of resected mitral valves after unsuccessful valvuloplasty.

OBJECTIVE: Percutaneous mitral valvuloplasty has been shown to be an acceptable alternative to surgery as treatment for selected patients with severe mitral stenosis. We examined hemodynamic, echocardiographic, and pathomorphologic findings in a series of 308 patients undergoing balloon valvuloplasty, 41 of whom underwent subsequent surgery, in search of possible predictors of an unsuccessful outcome. INTERVENTION AND RESULTS: Patients with severe mitral stenosis underwent Inoue single ballon valvuloplasty over a 48-month period and had follow-up for a mean of 14.5+/-16.8 months (range 1 to 64 months). Of the 308 patients, 267 (Group I) were clinically improved and stable throughout follow-up, while subsequent surgery was required in 41 (Group II) after 38.2+/-143.5 days (range 1 to 1212). Significant differences between the groups were observed for NYHA class (2.7+/-0.6 vs 2.9+/-0.6, p<0.05), mitral valve area (1.0+/-0.3 vs 0.9+/-0.2 cm2, p<0.01) and left atrial endsystolic dimension by echo (51.3+/-8.0 vs 55.4+/-10.2 mm, p<0.01). Two of the 41 Group II patients underwent surgery for left to right shunting, 1 for tamponade and 2 were lost to follow-up. The excised mitral valves of the remaining 36 patients all showed calcification and/or fibrosis: 9 homogenous, 5 non-homogenous; 19 were classified as having a funnel-shaped deformity, and 3 did not fit into a discrete category. Among the funnel-shaped valves, 13 had a tear versus 6 where dilation was primarily accomplished by stretching. Only one of 9 valves with homogenous calcification was torn, whereas a tear was noted in 3 of the 5 with non-homogenous calcification. CONCLUSION: Funnel-shaped valves and those with non-homogenous distribution of calcification and/or fibrosis appear to be least suitable for balloon valvuloplasty.

Predictors of unsuccessful outcome after percutaneous mitral valvulotomy including a new echocardiographic scoring system.

BACKGROUND AND AIMS OF THE STUDY: Percutaneous mitral valvulotomy has been shown to be an accept able alternative to surgery as treatment for selected patients with severe mitral stenosis. Uncertainty still exists regarding predictors of unsuccessful outcome. MATERIALS AND METHODS: 308 patients with severe mitral stenosis underwent Inoue single balloon valvulotomy over a 48-month period and were followed up for a mean of 14.5 +/- 16.8 months (range one to 64 months). Two hundred and sixty-seven (Group I) improved clinically and remained stable throughout the follow up, while subsequent surgery was required in 41 (Group II) after 38.2 +/- 143.5 days (range one to 1,212). Clinical and echocardiographic parameters of the two groups were compared to find significant predictors of an unsuccessful outcome. RESULTS: Significant differences between the groups were observed for NYHA class (2.7 +/- 0.6 vs. 2.9 +/- 0.6, p < 0.05), mitral valve area (1.0 +/- 0.3 vs. 0.9 +/- 0.2 cm2, p < 0.01), left atrial end-systolic dimension by echo (51.3 +/- 8.0 vs. 55.4 +/- 10.2 mm, p < 0.01) and an echocardiographic scoring system including grading for eccentricity of the mitral orifice and distribution of commissural calcification (7.5 +/- 2.0 for Group I and 8.7 +/- 2.0 for Group II, p < 0.001). CONCLUSIONS: Mitral valves that are more likely to have an unsuccessful outcome can be identified by hemodynamic, clinical and echocardiographic criteria, including grading for eccentricity of the mitral orifice and distribution of commissural calcification.

[Percutaneous mitral valvulotomy with the Inoue balloon in over 65-year-old patients--acute results and short-term follow-up in comparison with younger patients]. / Perkutane Mitralvalvulotomie mit dem Inoue-Ballon bei über 65jährigen Patienten--Akutergebnisse und kurzfristiger Verlauf im Vergleich zu jüngeren Patienten.

Percutaneous balloon mitral valvulotomy (PBMV) with the Inoue-balloon is a proven therapy in young patients with mitral stenosis. In this study, we investigated primary results in PBMV of elderly patients. In 383 patients with mitral stenosis PBMV was done with the Inoue-balloon. We compared primary success rates and short-term follow-up of 287 (74.9%) < 65-year-old patients and 96 (26.1%) > or = 65-year-old patients. Elderly patients were more likely to have atrial fibrillation (58% vs. 45%; p < 0.05), tricuspid regurgitation < or = II degrees (58% vs. 45%; p < 0.05), coronary artery disease (16% vs. 6%; p < 0.01), and previous pulmonary edema (42% vs. 30%; p < 0.05). PBMV was successful in 73.9% of the elderly and 84.7% of the younger patients (p < 0.05). Mitral valve gradients could be reduced from 12.5 +/- 11.6 mm Hg to 6.2 +/- 6.8 mmHg (p < 0.001) in elderly patients and from 15.5 +/- 6.9 mm Hg to 7.0 +/- 3.2 mm Hg (p < 0.001) in younger patients. Mitral valve areas increased from 1.0 +/- 0.3 cm2 to 1.6 +/- 0.5 cm2 (p < 0.001) in elderly patients and from 1.0 +/- 0.3 cm2 to 1.7 +/- 0.4 cm2 (p < 0.001) in younger patients. No patient died during the procedure. Two younger patients had emergency surgery because of pericardial tamponade following transseptal puncture. After PBMV elderly patients had more often an increase of mitral regurgitation (47% vs. 35%; p < 0.05) without need of an emergency mitral valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)