TY - JOUR
T1 - Percutaneous balloon mitral valvotomy for patients with mitral stenosis
T2 - Analysis of factors influencing early results
AU - Herrmann, H. C.
AU - Wilkins, G. T.
AU - Abascal, V. M.
AU - Weyman, A. E.
AU - Block, P. C.
AU - Palacios, I. F.
PY - 1988
Y1 - 1988
N2 - Percutaneous balloon mitral valvotomy has recently been developed as an alternative to surgical commissurotomy for patients with rheumatic mitral stenosis. We analyzed our initial experience with 60 consecutive procedures performed in 49 patients over 1 1/2 years and identified factors influencing the immediate hemodynamic results. For the total patient population, the mitral valve area increased after percutaneous mitral valvotomy from 0.8 ± 0.04 to 1.6 ± 0.11 cm2 (p < 0.001). Mean diastolic mitral gradient fell from 18 ± 1 to 7 ± 0.4 mm Hg (p < 0.001), and cardiac output increased from 3.8 ± 0.2 to 4.5 ± 0.2 L/min (p < 0.01). Although percutaneous mitral valvotomy resulted in an increase in mitral valve area in each patient, a suboptimal result, as defined by a postprocedure mitral valve area of 1.0 cm2 or less, an increase in area of 25% or less, or a final mitral gradient of 10 mm Hg or more occurred in 21 of the 60 procedures (35%). Multivariate analysis of 16 variables was performed to determine which factors might predict this result. Patients with a suboptimal result were more likely to have severe valve leaflet thickening or immobility and an extreme degree of subvalvular thickening and calcification on echocardiogram. Other factors that predicted a suboptimal result were a smaller effective balloon dilating area and the presence of atrial fibrillation. Thus optimal immediate hemodynamic results can be obtained in the majority of patients undergoing percutaneous mitral valvotomy. Optimal results may be expected in patients in normal sinus rhythm, with pliable mitral leaflets, and with no severe subvalvular disease identified by echocardiography, who undergo dilation with large effective balloon dilating areas.
AB - Percutaneous balloon mitral valvotomy has recently been developed as an alternative to surgical commissurotomy for patients with rheumatic mitral stenosis. We analyzed our initial experience with 60 consecutive procedures performed in 49 patients over 1 1/2 years and identified factors influencing the immediate hemodynamic results. For the total patient population, the mitral valve area increased after percutaneous mitral valvotomy from 0.8 ± 0.04 to 1.6 ± 0.11 cm2 (p < 0.001). Mean diastolic mitral gradient fell from 18 ± 1 to 7 ± 0.4 mm Hg (p < 0.001), and cardiac output increased from 3.8 ± 0.2 to 4.5 ± 0.2 L/min (p < 0.01). Although percutaneous mitral valvotomy resulted in an increase in mitral valve area in each patient, a suboptimal result, as defined by a postprocedure mitral valve area of 1.0 cm2 or less, an increase in area of 25% or less, or a final mitral gradient of 10 mm Hg or more occurred in 21 of the 60 procedures (35%). Multivariate analysis of 16 variables was performed to determine which factors might predict this result. Patients with a suboptimal result were more likely to have severe valve leaflet thickening or immobility and an extreme degree of subvalvular thickening and calcification on echocardiogram. Other factors that predicted a suboptimal result were a smaller effective balloon dilating area and the presence of atrial fibrillation. Thus optimal immediate hemodynamic results can be obtained in the majority of patients undergoing percutaneous mitral valvotomy. Optimal results may be expected in patients in normal sinus rhythm, with pliable mitral leaflets, and with no severe subvalvular disease identified by echocardiography, who undergo dilation with large effective balloon dilating areas.
UR - http://www.scopus.com/inward/record.url?scp=0023687645&partnerID=8YFLogxK
U2 - 10.1016/s0022-5223(19)35294-8
DO - 10.1016/s0022-5223(19)35294-8
M3 - Article
C2 - 3386292
AN - SCOPUS:0023687645
SN - 0022-5223
VL - 96
SP - 33
EP - 38
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -