Balloon mitral valvuloplasty in low flow low gradient/normal flow low gradient severe mitral stenosis: Immediate and short term outcomes

Background: The aim of the present study was to study the effect of percutaneous balloon mitral valvuloplasty (PBMV) on P wave dispersion and to test the correlation between P-maximum and P-dispersion to right ventricular function and pulmonary artery pressure before and after PMBV. Also to study the impact of P-maximum and P-wave dispersion on the short term clinical outcome after successful PBMV in patients with mitral stenosis (MS) and sinus rhythm. Methods: 75 patients undergoing PMBV were enrolled in this study. We evaluated P-maximum, P-minimum and P-wave dispersion before and one month and one year after PBMV . We studied the changes in pulmonary arterial pressure (PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve area, in addition to the changes in right ventricular function utilizing tissue Doppler assessment both before and after PMBV, in addition the role of the P-wave dispersion in prediction of late cardiac events. Results: There were significant decrease in mean diastolic gradient, PAP, and LA size and significant improvement in right ventricular tissue Doppler indices after PMBV. Accompany these hemodynamic changes after PMBV. P-maximum and P-wave dispersion were found to be decreased (P < 0.001). Conclusion: Successful PBMV was associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV. The P-maximum and P-wave dispersion changes were correlated with significant impairment of right dysfunction and the degree of pulmonary artery pressure. Keywords: PBMV.PAP,LA

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Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(00)01184-0 ◽

2001 ◽

Vol 37 (3) ◽

pp. 900-903 ◽

Cited By ~ 87

Author(s):

José A.M de Souza ◽

Eulogio E Martinez ◽

John A Ambrose ◽

Claudia M.R Alves ◽

Daniel Born ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Mitral Valvuloplasty ◽

Percutaneous Balloon Mitral Valvuloplasty ◽

Percutaneous Balloon

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Abstract 12660: Impact of Aortic Valve Replacement versus Medical Management on Survival of Low Flow Low Gradient Severe Aortic Stenosis With Normal Ejection Fraction

Circulation ◽

10.1161/circ.132.suppl_3.12660 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Zaher Fanari ◽

Dimitrios Barmpouletos ◽

Vivek K Reddy ◽

Sumaya Hammami ◽

Zugui Zhang ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Low Flow ◽

Rank Test ◽

Normal Ejection Fraction ◽

Normal Flow ◽

Log Rank Test

Background: The impact of aortic valve replacement (AVR) versus medical management (MM) in patients with paradoxical low flow is unclear. The objective of this study was to compare outcomes of AVR versus MM in patients with severe aortic stenosis and normal ejection fraction and different transaortic flow and gradient. Methods: We identified consecutive patients presenting to our echo lab with an aortic valve area (AVA) < 1.0cm 2 and EF≥ 50%. We stratify patients depending on gradient (≥ 40 vs. < 40 mmHg) and stroke volume index (SVI < 35 vs. ≥35 ml/m 2 ). 4 groups were identified (, normal flow, high gradient [NF/HG]; normal flow, low gradient [NF/LG]; low flow, high gradient [LF/HG] and low flow, low gradient [LF/LG]. These 4 groups were also stratified depending on management (AVR vs. MM). All patients were retrospectively followed for the occurrence of death. Results: A total of 954 patients were included in analysis. Mean follow up was 2.45 ± 1.9 years. The mean age was 75.4 ± 5.6 years. Comparing all 4 AS subgroups, the mortality was higher in LF/HG followed by LF/LG, NF/HG and NF/LG (LF/HG 37.1% vs. LF/LG 33.9% vs. NF/HG 30.3%vs. NF/LG 20.2%; Log Rank Test, P=0.003). Patients who underwent medical therapy have a higher mortality than the overall cohort in all subgroups (LF/HG 44.3% vs. NF/HG 36.6% vs. LF/LG 33.7% vs. NF/LG 21.2%; Log Rank Test, P=0.001). Patients with HG had a higher chance of getting aortic valve replacement (AVR) than those with LF/LG and NF/LG (20.7% NF/HG vs. 10.6% LF/HG vs. 4.7% LF/LG and 3.6% NF/LG; P=0.01). Patients who underwent AVR had lower mortality rates when compared with the overall cohort in all subgroups (LF/HG 21.4% vs. 18.9% NF/HG vs. 6.6% LF/LG and 7.1% NF/LG; Log Rank Test, P= 0.253). Conclusion: Patients with LF/LG represent an under-recognized high-risk group with similar prognosis to NF/HG. Although these patients may benefit tremendously from AVR, they are less likely to undergo AVR when compared to HG patients.

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