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Echocardiographic Long‐Term Evaluation of Percutaneous Balloon Mitral Valvotomy
Author(s) -
CASTILLO JOSE MARIA DEL,
MIYAHIRA NELSON,
ZULIANI MARIA FERNANDA M.,
MANGIONE JOSE ARMANDO,
ARIE SIGUEMITUZO
Publication year - 1992
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.1992.tb00479.x
Subject(s) - medicine , cardiology , percutaneous , mitral valve , mitral valve stenosis , stenosis , color doppler , balloon , calcification , hemodynamics , surgery , ultrasonography
Percutaneous balloon mitral valvotomy (BMV) is an alternative therapeutic method for patients with mitral stenosis. We studied 62 patients (56 females, mean age 36.4 years) who underwent balloon mitral valvotomy. Five patients were pregnant and in New York Heart Association Functional Class IV. Doppler echocardiographic studies were performed prior to the procedure, and at 7 days, 6 months, 12 months, and 24 months after the procedure. We studied the following parameters: echo‐score by the sum of valvular mobility, thickening, and calcification, and subvalvular disease, graded from 1 to 4; and mitral valve area (MVA) and mitral pressure gradient (MPG) by Doppler echocardiography. The patients were separated into two groups: group I with an echo‐score 8 (40 patients), and group II with an echo‐score 9 (22 patients). Mitral valve area and MPG were compared with hemodynamics through the correlation coefficient and linear regression. Comparison between groups I and II was performed using the unpaired Student's t‐test. Follow‐up of MVA and MPG was analyzed by analysis of variance. The Student's t‐test did not show any significant difference between MVA and MPG before balloon mitral valvotomy. There was significant decrease of MVA in group II (P<0.01) in the last three studies. There was significant increase in MPG in group II (P<0.01) in every postvalvotomy study. The analysis of variance of group I showed statistical increase of the MVA, and significant decrease of the MPC after BMV. The analysis of variance of group II showed significant increase in MVA and significant decrease in MPG between the pre‐ and the first postvalvotomy study. There was significant decrease (P<0.01) in MVA, and increase in MPG in the three postvalvotomy studies. Complications included mitral regurgitation, residual interatrial communication, pericardial effusion due to an atrial wall perforation, and peripheral embolization. Atrial fibrillation did not significantly alter the results of BMV. Results were considered positive when MVA was>1.5 cm 2 and area increase was>25%. Patients with an echo‐score 8 (group I) benefit from BMV, with a positive predictive value > 78%. In pregnant patients the symptomatology was alleviated by BMV, without any signs of fetal compromise.