Balloon Mitral Valvotomy in Gestational Women with Symptomatic Mitral Stenosis

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.

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

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.

Closed Mitral Valvotomy for Mitral Stenosis in Mirror Image Dextrocardia

1995 ◽  
Vol 3 (2) ◽  
pp. 75-77 ◽  
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.

Abstract 19359: A Novel Parameter to Predict Long-term Cardiac Mortality in Mitral Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Maria Carmo P Nunes ◽  
Timothy Tan ◽  
Sammy Elmariah ◽  
Lucas Lodi-Junqueira ◽  
Bruno R Nascimento ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Mitral Stenosis ◽  
Strong Predictor ◽  
Pulmonary Vasculature ◽  
Cardiac Mortality ◽  
Class Iii ◽  
Artery Pressure ◽  
Rv Function ◽  
Valve Area

The prognosis of patients with mitral stenosis (MS) depends on the severity of obstruction and hemodynamic burden affecting the pulmonary vasculature. Net atrioventricular compliance (C n ) reflects the overall adverse hemodynamic consequence of MS and may be useful in predicting mortality. Methods: A total of 402 MS patients (mean age 51 ± 16 years, valve area of 1.04 ± 0.24 cm 2 , 84% female) undergoing percutaneous mitral valvuloplasty (PMV) between 2000 and 2013 at 2 centers were enrolled. Invasive hemodynamic and echocardiographic measures (pre and 24 hours post PMV) were examined and patients were followed for a median of 28 months post PMV. Endpoints were cardiovascular death (primary), and a composite of death from any cause, mitral valve replacement (MVR) or repeat PMV (secondary). Results: At baseline, 138 (34%) were in atrial fibrillation and 48% were NYHA functional class III or IV. PMV resulted in significant increase in valve area, decrease in transmitral pressure gradients, pulmonary pressures and an improvement in right ventricular (RV) function. A total of 47 (12%) died (39 cardiovascular deaths). In addition, 48 patients underwent MVR, and 12 required repeat PMV with an overall incidence of adverse events of 11.4 events per 100 patient-years. Baseline C n was a strong predictor of both cardiac death (adjusted hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49 - 0.86, p = 0.008), and composite endpoint (adjusted HR 0.81, 95% CI 0.67 - 0.91, p = 0.016). Cardiac mortality was significantly higher in patients with C n ≤ 4 ml/mmHg than in patients with C n > 4 ml/mmHg (adjusted HR 0.35, 95% CI 0.16 - 0.75, p=0.007), after adjusting for clinical factors, pulmonary artery pressure, tricuspid regurgitation (TR) severity, RV function and immediate procedural results. Survival rate at 1-, 3- and 5-years follow-up was 96%, 94% and 87% in patients with C n > 4 ml/mmHg compared to 89%, 79% and 75% in patients with C n ≤ 4 ml/mmHg. Conclusions: Baseline C n is a strong predictor of cardiovascular-related mortality in patients with significant MS, after adjustment for other prognostic factors including postprocedural pulmonary artery pressure. C n assessment therefore has potential value in evaluation of mortality risk in the setting of MS.

scholarly journals Per-operative Changes of Pulmonary Artery Pressure following Closed Mitral Commissurotomy

2019 ◽  
Vol 11 (2) ◽  
pp. 147-151
Author(s):  
Muhammed Abdul Quaium Chowdhury ◽  
Mohammad Fazle Maruf ◽  
Minhazur Rahman ◽  
Subir Barua ◽  
Mamunur Rahman ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Artery Pressure ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Background: Mitral stenosis is often present with pulmonary hypertension. Closed Mitral Commissurotomy (CMC) is a treatment of choice for severe mitral stenosis. In this study, we examined the per-operative changes of pulmonary artery pressure following opening of stenosed mitral valve. Methods: All these CMCs were performed routinely through the left antero-lateral thoracotomy (4th intercostal space) and dilatation was done by metallic Tubb’s Dilator. Peroperative left atrial and Pulminary Arterial pressures were measured before and after dilatation. Results: 15 patients had undergone CMC. Following CMC, per-operative mean Pulmonary artery pressure was reduced from 45.5±7.1 mm of Hg to 39.0±8.8 mm of Hg (p=0.043). Mean left atrial pressure reduced from 35.9±5.6 mm of Hg to 30.0±9.1 mm of Hg (p = 0.049). At three months follow up after closed mitral commissurotomy mitral valve area at echocardiography was found 2.29±0.18 cm2. There was no case of death after closed mitral commissurotomy. Mild mitral regurgitation occurred in 1 patient. Conclusion: We conclude that there is immediate significant reduction of pulmonary Artery pressure following closed mitral commissurotomy. This reduction is apparently comparable with a similar reduction of left atrial pressure. Cardiovasc. j. 2019; 11(2): 147-151

scholarly journals An analysis of percutaneous balloon mitral valvotomy: a tertiary care centre study

2020 ◽  
Vol 7 (6) ◽  
pp. 924
Author(s):  
Prem Kumar Thota ◽  
Rajesh Dake
Keyword(s):  
Mitral Valve ◽  
Mitral Stenosis ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Mitral Valve Area ◽  
Percutaneous Balloon ◽  
Number Of Patients ◽  
Study Population ◽  
Mitral Valvotomy ◽  
Valve Area

Background: The prevalence of rheumatic heart disease (RHD) has markedly decreased in several countries but is still present in underdeveloped and developing countries, 33 million people around the world affected by RHD. Percutaneous balloon mitral valvotomy (PBMV) or valvotomy via femoral cut down using a balloon dilating catheter used in a small number of patients` as an alternative to surgical mitral commissurotomy.Methods: A retrospective, observational study included 37 patients who were diagnosed to have severe mitral stenosis between October 2017 and October 2019 were included in the study. Primary endpoint was considered as in-hospital mortality and secondary endpoint was considered as 6 months clinical outcomes. All patients were evaluated clinically by the same investigator who performed PBMV.Results: The mean age of the study population was 36.6±11.37 years. There was a female predominance 27 (72.97%) patients. Out of total patients; an optimal result was achieved in 33 (89.19%) patients, 1patient developed pericardial effusion and for 3 (8.1%) patients wire cannot be crossed. Although the mitral valve area calculated by cardiac catheterization increased significantly from immediately before 1.003±0.12cm2 to immediately after PBMV 1.73±0.23cm2 there was a no significant decrease in the mitral valve area at 6 months follow-up 1.66±0.22cm2 by Echocardiography.Conclusions: PBMV is an effective treatment for acquired mitral stenosis, as demonstrated by the immediate hemodynamic results in 37 consecutive procedures. PBMV is effective therapy with good midterm results for selected patients with mitral stenosis.

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