Unusual sequelae after percutaneous mitral valvuloplasty: A Doppler echocardiographic study

Percutaneous mitral valvuloplasty is a promising new technique for the treatment of mitral stenosis, with a relatively low complication rate reported to date. To assess the sequelae of this procedure, Doppler echocardiographic studies were prospectively performed before and after percutaneous mitral valvuloplasty in a series of 172 patients (mean age 53 ± 17 years). After balloon dilation, mitral valve area increased from 0.9 ± 0.3 to 2 ± 0.8 cm² (p < 0.0001), mean gradient decreased from 16 ± 6 to 6 ± 3 mm Hg (p < 0.0001) and mean left atrial pressure decreased from 24 ± 7 to 14 ± 6 mm Hg (p < 0.0001). Although most patients were symptomatically improved, six (4%) were identified who had unusual sequelae evident on Doppler echocardiographic examination immediately after percutaneous mitral valvuloplasty. These included rupture of a posterior mitral valve leaflet, producing a flail distal leaflet portion with severe mitral regurgitation detected on Doppler color flow mapping (n = 1); asymptomatic rupture of the chordae tendineae attached to the anterior mitral valve leaflet with systolic anterior motion of the ruptured chordae into the left ventricular outflow tract (n = 1); a double-orifice mitral valve (n = 1); and evidence of a tear in the anterior mitral valve leaflet (n = 3), producing on both pulsed Doppler ultrasound and color flow mapping a second discrete jet of mitral regurgitation in addition to regurgitation through the main mitral valve orifice. All six patients made a satisfactory recovery and none has required mitral valve replacement. In a small percent of cases, percutaneous mitral valvuloplasty may produce unusual disruption of the mitral valve and supporting apparatus that may be readily detected by Doppler echocardiographic studies.