Impact of successful percutaneous balloon mitral valvuloplasty on pulmonary vascular resistance and right ventricular functions

BackgroundMitral stenosis (MS) still results in significant morbidity and mortality worldwide. Percutaneous balloon mitral “valvuloplasty” commissurotomy (PMC) as invasive, nonsurgical procedure is safe and effective therapeutic modality in selected patients with rheumatic MS. Right ventricular (RV) function abnormalities play an important role in the development of clinical symptoms and the overall prognosis of patients with MS, It occurs early before the systemic venous congestion develops, so it has been shown to be a major determinant of clinical outcome. Severe pulmonary hypertension (PH) is present in about 38% of severe MS cases. Pulmonary vascular disease frequently complicates long standing MS and may significantly influence prognosis. Non-invasive estimation of pulmonary vascular resistance (PVR) correlates strongly with invasive measures at both normal and elevated pulmonary pressures.ObjectivesAssess the effects of successful PMC on PVR and RV functions, immediately and after 6 month using new Doppler echocardiographic indices.Patient and methods50 consecutive patients; 45 females (90%) & 5 males (10%) with isolated moderate and severe rheumatic MS underwent successful PMC. All of the following parameters were measured before PMC, Immediately after PMC and after 6 months of PMC using transthoracic echocardiography: Mitral valve area (MVA), peak diastolic pressure gradient (PDPG), mean diastolic pressure gradient (MDPG), pulmonary acceleration time (PAT), mean pulmonary artery pressure (MPAP), tricuspid regurge velocity (TRV), right ventricular systolic pressure (RVSP), right ventricular ejection fraction (RVEF), right ventricular outflow time velocity integral (RVOTTVI), right ventricular outflow tract fractional shortening (RVOTfs), tricuspid annular plane systolic excursion (TAPSE) and pulmonary vascular resistance (PVR) was calculated as PVR=TRVm/s/TVIRVOT cm x 10+ 0.16.ConclusionsPMC has a very favorable impact on progressive and sustained improvement of RV functions, regression of pulmonary artery pressure and recovery of PVR (measured non-invasively) on short term and after 6 months of follow up. Regression of TRV was strong predictor for recovery of PVR and RVSP while improvement of RVOTFS was a strong predictor of recovery of RVEF