Comparison of mitral valve area, pulmonary function and pulmonary artery hypertension in patients with chronic rheumatic

Abstract Introduction Percutaneous mitral balloon valvuloplasty is effective in mitral stenosis. Objectives: to evaluate prior mitral surgical commissurotomy (PMC) and echocardiographic score (ES) in the results and complications of mitral balloon valvuloplasty (MBV). Methods From 1987 to 2013, 526 procedures with Inoue balloon, double or single Balt balloon technique; 480 without PMC named primary MBV group (PMBVG) and 46 that have been submitted to PMC, the PMC group. The PMCG was older than PMBVG (42.7±12.4 vs 36.9±12.5 years, p=0.0030). Gender, atrial fibrilation and NYHA functional class were similar. In PMBVG and PMCG, respectively, ES were 7.2±1,4 and 7.7±1.5 points (p=0.0158) and mitral valve area (MVA) 0.94±0.21 and 1.00±0.22 cm2 (p=0.0699). Results Pre-MBV: mean pulmonary artery pressures (MPAP) were 37.8±14.2 and 37.6±14.4 mmHg, p=0.9515; mean gradient (MG) 19.6±6.9 and 18.3±6.9 mmHg, p=0.2342; MVA 0.90±0.21 and 0.93±0.19 cm2, p=0.4092, respectively, whem compare PMBVG and PMCG. Post-MBV: MPAP were 26.8±10.2 and 26.6±10.9 mmHg, p=0.9062; MG 5.4±3.5 and 6.3±4.2 mmHg, p=0.1492; MVA 2.04±0.42 and 1.92±0.41 cm2, p=0.0801, respectively. Mitral regurgitation (MR) were similar pre and post-MBV. Severe MR post-MBV in 10 patients: 8 in PMBVG and 2 in PMCG, p=0.2048. As there were not found significant diferences, the total group were divided in ES ≤8 and >8 groups: Pre-MBV: MPAP 37.5±13.9 and 39.3±16.6 mmHg, p=0.4041; MG 19.7±6.8 and 18.3±7.3 mmHg, p=0.1753; MVA 0.90±0.21 and 0.94±0.20 cm2, p=0.0090 respectively. Post-MBV: MPAP 26.7±10.1 and 28.0±10.6 mmHg, p=0.3730, MG 5.5±3.6 and 5.5±3.3 mmHg, MVA 2.06±0.42 and 1.90±0.40 cm2, p=0.0090. Conclusion The groups with and without prior mitral commissurotomy in MBV were compare and no differences were found in pre- and post-procedure, as mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Although PMCG was older, with higher ES, its hemodynamics datas were similar. Whem the entire group was divided based on echo scores, those with echo scores >8 had highse MV (p=0.0090). and smaler mitral valve areas post-valvuloplasty. The valve anatomy were more important than prior commissurotomy. Funding Acknowledgement Type of funding source: None

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P4718Inadequate response of pulmonary artery pressure after percutaneous mitral valvuloplasty: determinant factors and prognostic impact

European Heart Journal ◽

10.1093/eurheartj/ehz745.1098 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

I F Sales ◽

M E Alcici ◽

G R S A Athayde ◽

V T Ribeiro ◽

T D Diamantino ◽

...

Keyword(s):

Mitral Valve ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Left Ventricular ◽

Inadequate Response ◽

Artery Pressure ◽

Mitral Valve Area ◽

Ventricular Compliance ◽

Valve Area

Abstract Introduction Pulmonary hypertension (HP) has long been known to be a marker of poor outcome in patients with mitral stenosis (MS). Percutaneous mitral valvuloplasty (PMV) is currently the treatment of choice for MS, which results in improvement in HP. However, despite the successful valve opening, the regression of PH may be incomplete. This has been attributed to irreversible morphologic changes within the pulmonary vasculature. Purpose To assess the clinical, echocardiographic and hemodynamic parameters associated with an inadequate response of the pulmonary artery pressure (PAP) immediately after a successful PMV, and also the impact of residual PH on long-term outcome in these patients. Methods 181 patients undergoing PMV for rheumatic MS were enrolled. Invasive hemodynamic and echocardiographic measures were examined in all patients. Inadequate response of PAP was defined as the mean pulmonary artery pressure (mPAP) values unchanged at the end of the procedure. Long-term outcome was a composite endpoint of death, mitral valve replacement, repeat PMV, new onset of atrial fibrillation (AF), or stroke. Results The mean age was 44.1±12.6 years, and 157 patients were women (86.7%). In the overall population, mPAP decreased from 33.4±13.1 mmHg pre to 27.6±9.8 mmHg post (p<0.001), as mitral valve increased from 0.96±0.2 cm2 pre to 1.68±0.2 cm2 post (p<0.001) PMV. Following PMV, 10 patients developed severe mitral regurgitation and were excluded from the analysis. Of the 171 patients analyzed, 52 (30%) did not present reduction of mPAP immediately after the PMV. Transmitral pressure gradients were significantly greater and mitral valve area was smaller in those patients with unchanged mPAP after PMV than in those whose PAP had decreased. Systolic, diastolic and mPAP pressures as well as left atrial pressure were higher in those patients who had improvement in pulmonary pressures after PMV. Multivariate analysis revealed the following independent predictors of unchanged mPAP: AF (Odds ratio [OR] 2.7, 95% [confidence interval] CI 1.1 to 6.4), mitral valve area (OR 1.3, 95% CI 1.1 to 1.5), maximum mitral valve leaflets displacement (OR 0.8, 95% CI 0.7 to 0.9), and left ventricular compliance after PMV (OR 0.8, 95% CI 0.6 to 0.9). During a mean follow-up of 28 months, the endpoint was reached in 48 patients (26%). The pulmonary pressure response to PMV was not predictor of long-term events. Conclusions In a large cohort of patients with MS undergoing PMV, mean pulmonary artery pressure values do not reduce immediately after the procedure in 30% of the cases, despite adequate opening of the valve. The factors associated with inadequate PAP response following PMV were presence of AF, larger mitral valve area, reduced valve leaflets mobility and post procedural low left ventricular compliance. The early non-reduction of mPAP after PMV is not associated with adverse outcome.

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Balloon Mitral Valvotomy in Gestational Women with Symptomatic Mitral Stenosis

Cardiology and Angiology An International Journal ◽

10.9734/ca/2020/v9i330134 ◽

2020 ◽

pp. 1-7

Author(s):

Prem Krishna Anandan ◽

Arun Kaushik ◽

K. Tamilarasu ◽

G. Rajendran ◽

Shanmuga Sundaram ◽

...

Keyword(s):

Mitral Valve ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Mitral Stenosis ◽

Intrauterine Growth Restriction ◽

Mitral Valvuloplasty ◽

Artery Pressure ◽

Mitral Valve Area ◽

Mitral Valvotomy ◽

Valve Area

Background: Rheumatic valvular heart disease, commonly mitral stenosis, complicate 1% of pregnancies. Balloon mitral valvuloplasty (BMV) is an established treatment of rheumatic mitral stenosis. Aim of the study was to assess the safety and efficacy of Balloon mitral valvuloplasty in pregnant women with severe mitral stenosis. Materials and Methods: 66 patients who failed to respond to medical therapy undergoing BMV during pregnancy were analysed in this retrospective study. Mitral valve area (MVA), transmitral Mean valve gradient (MVG), and mitral regurgitation (MR), Pulmonary artery pressure (PAP) were assessed before and 24 hours after the procedure by transthoracic echocardiography. Patients were followed up to one month post BMV and neonates were monitored for the adverse effect of radiation. Results: Mitral valve area increased from 0.83 ± 0.13 cm2 to 1.38 ± 0.29 cm2 (P = 0.007). Mean gradient mitral valve gradient decreased from 15.5 ± 7.4 mmHg to 3.36 ± 2.36 mmHg (P = 0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 (P = 0.012). No maternal death, intrauterine growth restriction was observed. Conclusion: Balloon mitral valvuloplasty has favourable immediate good outcomes for mothers and newborns.

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Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02175-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yahya Dadjo ◽

Maryam Moshkani Farahani ◽

Reza Nowshad ◽

Mohsen Sadeghi Ghahrodi ◽

Alireza Moaref ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Protective Factor ◽

Cardiac Events ◽

Mitral Valve Area ◽

Adverse Cardiac Events ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy ◽

Valve Area

Abstract Background Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. Methods In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. Results During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). Conclusion The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).

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Two-dimensional-Wilkins and real-time transesophageal three-dimensional scoring systems: Which one is preferred to mitral valve morphological assessment?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211030424 ◽

2021 ◽

pp. 021849232110304

Author(s):

Mehrnoush Toufan ◽

Zahra Jabbary ◽

Naser Khezerlou aghdam

Keyword(s):

Mitral Valve ◽

Transthoracic Echocardiography ◽

Scoring System ◽

Three Dimensional ◽

Scoring Systems ◽

Two Dimensional ◽

Mitral Valve Area ◽

2D And 3D ◽

Morphological Assessment ◽

Valve Area

Background To quantify valvular morphological assessment, some two-dimensional (2D) and three-dimensional (3D) scoring systems have been developed to target the patients for balloon mitral valvuloplasty; however, each scoring system has some potential limitations. To achieve the best scoring system with the most features and the least restrictions, it is necessary to check the degree of overlap of these systems. Also the factors related to the accuracy of these systems should be studied. We aimed to determine the correlation between the 2D Wilkins and real-time transesophageal three-dimensional (RT3D-TEE) scoring systems. Methods This cross-sectional study was performed on 156 patients with moderate to severe mitral stenosis who were candidates for percutaneous balloon valvuloplasty. To morphologic assessment of mitral valve, patients were examined by 2D-transthoracic echocardiography and RT3D-TEE techniques on the same day. Results A strong association was found between total Wilkins and total RT3D-TEE scores (r = 0.809, p < 0.001). The mean mitral valve area assessed by the 2D and 3D was 1.07 ± 0.25 and 1.03 ± 0.26, respectively, indicating a mean difference of 0.037 cm2 (p = 0.001). We found a strong correlation between the values of mitral valve area assessed by 2D and 3D techniques (r = 0.846, p < 0.001). Conclusion There is a high correlation between the two scoring systems in terms of evaluating dominant morphological features. Partially, mitral valve area overestimation in the 2D-transthoracic echocardiography and its inability to assess commissural involvement as well as its dependence on patient age were exceptions in this study.

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Two-dimensional transesophageal echocardiographic determination of mitral valve area in adults with mitral stenosis

American Heart Journal ◽

10.1016/0002-8703(94)90055-8 ◽

1994 ◽

Vol 127 (5) ◽

pp. 1348-1353 ◽

Cited By ~ 6

Author(s):

Marcus F Stoddard ◽

Charles R Prince ◽

Nasar M Ammash ◽

John L Goad

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Two Dimensional ◽

Mitral Valve Area ◽

Valve Area

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Closed Mitral Valvotomy for Mitral Stenosis in Mirror Image Dextrocardia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239500300211 ◽

1995 ◽

Vol 3 (2) ◽

pp. 75-77 ◽

Cited By ~ 1

Author(s):

Gutti Ramasubrahmanyam ◽

Dronamraju Dilip ◽

Pirovam Venkat Ramnarayan ◽

Raju Subramaniam Iyer ◽

Kothapalle Venugopal Naidu

Keyword(s):

Mitral Valve ◽

Surgical Approach ◽

Mitral Stenosis ◽

Mirror Image ◽

Abnormal Position ◽

Mitral Valve Area ◽

Anterolateral Thoracotomy ◽

Mitral Valvotomy ◽

Valve Area

A 22-year-old female with mirror image dextrocardia and rheumatic valvular mitral stenosis underwent closed mitral valvotomy using a Tubb's dilator with good results. Despite abnormal position of situs, the surgical approach was simple through right anterolateral thoracotomy, and the operator's hands were mirror image to that of levocardia valvotomy in certain steps. Preoperative mitral valve area was 0.8 cm2, and peak and mean diastolic gradients were 21 and 15 mmHg respectively. Postoperatively, valve area improved to 2.16 cm2, and peak and mean diastolic gradients were 8 and 3.1 mmHg, respectively.

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