Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy

doi:10.1016/0002-9149(91)90619-V

The American Journal of Cardiology

Volume 67, Issue 9, 15 April 1991, Pages 854-862

https://doi.org/10.1016/0002-9149(91)90619-V Get rights and content

Abstract

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 219 patients with symptomatic, severe rheumatic mitral stenosis. There were 59 men and 160 women, aged 19 to 76 years (mean 43). Pliable, noncalcified valves were present in 139 (group 1), and calcified valves or severe mitral subvalvular lesions, or both, in 80 patients (group 2). Atrial fibrillation was present in 133 patients (61%) and 1+ or 2+ mitral regurgitation in 59 (27%). Technical failure occurred with 3 patients in our early experience. There was no cardiac tamponade or emergency surgery. The only in-hospital death occurred 3 days after the procedure in a group 2 premoribund patient in whom last-resort PTMC created 3+ mitral regurgitation. Mitral regurgitation appeared or increased in 72 patients (33%); 3+ mitral regurgitation resulted in 12 patients (6%). There were 3 systemic embolisms. Atrial left-to-right shunts measured by oximetry developed in 33 patients (15%). Immediately after PTMC, there were significantly reduced (p = 0.0001) left atrial pressure (24.2 ± 5.6 to 15.1 ± 5.1 mm Hg), mean pulmonary artery pressure (39.7 ± 13.0 to 30.6 ± 10.9 mm Hg) and mitral valve gradient (13.0 ± 5.1 to 5.7 ± 2.6 mm Hg). Mitral valve area increased from 1.0 ± 0.3 to 2.0 ± 0.7 cm² (p = 0.0001) and cardiac output from 4.4 ± 1.4 to 4.7 ±1.2 liters/min (p < 0.01). The results mirrored clinical improvements in 209 patients (97%). Multivariate analysis showed an echo score >8, and valvular calcification and severe subvalvular lesions as independent predictors for suboptimal hemodynamic results. The cardiovascular event-free survival rate for group 1 was 100% up to 42 months; that for group 2 was 91% at 12 months, and held at 76% from 24 to 31 months. PTMC is safe, achieves good immediate and long-term results and is the procedure of choice in selected patients with mitral stenosis.

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Cited by (191)

Efficacy and safety of percutaneous mitral balloon valvotomy in patients with mitral stenosis: A systematic review and meta-analysis
2021, IJC Heart and Vasculature
Percutaneous mitral balloon valvotomy PMBV is an acceptable alternative to Mitral valve surgery for patients with mitral stenosis. The purpose of this study was to explore the immediate results of PMBV with respect to echocardiographic changes, outcomes, and complications, using a meta-analysis approach.
MEDLINE, and EMBASE databases were searched (01/2012 to 10/2018) for original research articles regarding the efficacy and safety of PMBV. Two reviewers independently screened references for inclusion and abstracted data including article details and echocardiographic parameters before and 24–72 h after PMBV, follow-up duration, and acute complications. Disagreements were resolved by third adjudicator. Quality of all included studies was evaluated using the Newcastle-Ottawa Scale NOS.
44/990 references met the inclusion criteria representing 6537 patients. Our findings suggest that PMBV leads to a significant increase in MVA (MD = 0.81 cm²; 0.76–0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52–3.26, p = 0.007), LVEDV EDV (MD = 5.81 ml; 2.65–8.97, p = 0.0003) and decrease in MPG (MD = −7.96 mmHg; −8.73 to −7.20, p < 0.00001), LAP (MD = −10.09 mmHg; −11.06 to −9.12, p < 0.00001), and SPAP (MD = −15.55 mmHg; −17.92 to −13.18, p < 0.00001). On short term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7%% respectively. On long term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7% respectively
PMBV represents a successful approach for patients with mitral stenosis as evidenced by improvement in echocardiographic parameters and low rate of complications.
Intracardiac echocardiography–guided simultaneous pulmonary vein isolation and percutaneous transvenous mitral commissurotomy
2020, HeartRhythm Case Reports
Results of percutaneous mitral balloon commissurotomy in pregnant women about 12 cases
2018, Annales de Cardiologie et d'Angeiologie
Le rétrécissement mitral (RM) est la cardiopathie valvulaire la plus fréquemment révélée ou aggravée par la gestation. La commissurotomie mitrale percutanée (CMP) est actuellement le traitement de choix.
Le but de l’étude était d’évaluer les résultats à court, moyen et long terme de la commissurotomie mitrale percutanée chez des femmes enceintes présentant un rétrécissement mitral serré symptomatique.
Il s’agit d’une étude rétrospective incluant 12 patientes enceintes porteuses de rétrécissement mitral serré, hospitalisées dans le service de cardiologie de l’hôpital Habib Thameur entre 1994 et 2014 et ayant bénéficié d’une commissurotomie mitrale percutanée par ballon d’Inoué avec un suivi de plus de 15 ans.
L’âge moyen des patientes était de 31,5 ± 4,4 ans. Toutes nos patientes étaient symptomatiques et une insuffisance mitrale modérée était notée dans quatre cas. Immédiatement après la procédure, une amélioration fonctionnelle était constatée dans tous les cas et la surface mitrale est passée de 1,02 ± 0,5 cm² à 2 ± 0,35 cm². L’insuffisance mitrale était aggravée dans trois cas et nouvellement créée dans deux cas. Toutes les patientes ont accouché à terme. Les nouveau-nés étaient tous en bonne santé apparente et seulement deux d’entre eux étaient hypotrophes. Avec un recul moyen de 95,58 ± 64,1 mois, cinq patientes ont présenté une resténose mitrale dont deux ont eu un remplacement valvulaire et trois ont bénéficié de redilatation percutanée.
L’efficacité de la commissurotomie mitrale percutanée est clairement documentée par l’évaluation clinique et échocardiographique. Dans le cas particulier de la grossesse, le but n’est pas tant d’obtenir un résultat optimal que d’entraîner une amélioration hémodynamique autorisant la poursuite de la grossesse et l’accouchement.
Mitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable.
The purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment.
It is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years.
Mean patients age was 31.5 ± 4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02 ± 0.5 cm² averaged to 2 ± 0.35 cm². Mitral regurgitation increased in three cases and appeared in two cases. All patients delivered at term. Newborns were all healthy. Two of them had a low birth weight. On the long term follow-up (95.58 ± 64.1 months), five patients had mitral restenosis: two had a surgical valve replacement and three underwent a second percutaneous mitral balloon commissurotomy.
The effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth.
Percutaneous transvenous mitral commissurotomy in mitral stenosis and left atrial appendage clot patients in special conditions: Hospital-based study
2016, Indian Heart Journal
The percutaneous transvenous mitral commissurotomy is an important procedure for the treatment of mitral stenosis. A lot of mitral stenosis cases have left atrial appendage clot which precludes the patient from the benefit of this procedure.
The aim of the study was to study the feasibility and safety of the procedure in a patient with appendage clot in the setup of certain urgent conditions.
All cases of mitral stenosis with significant dyspnea and mitral valve area <1.5 cm² with left atrial appendage clot and a condition which would preclude the patient from continuing on anticoagulation and needed urgent intervention were included in the study. From January 2011 to December 2013, twenty patients coming to Shahid Gangalal National Heart Centre, Kathmandu were selected for the procedure with conventional sampling technique. Informed written consent was obtained from the patients explaining all possible complications. The approval of the study was taken from the ethical committee of the hospital.
Mean mitral valve area increased from 0.90 cm² (SD ± 0.14) to 1.5 cm² (SD ± 0.21) (p = 0.02). Left atrial mean pressure decreased from mean of 20 to 10 mmHg. Subjective improvement was reported in all. All of the patients had fulfilled criteria for successful PTMC. There was no mortality during hospital stay or in one-week follow-up period. There were no neurological complications or any need for emergency surgery.
The immediate result of percutaneous transvenous mitral commissurotomy in selected cases of mitral stenosis with left atrial appendage clot is safe and acceptable in certain urgent situations in experienced hands.
Immediate effect of percutaneous transvenous mitral commissurotomy on atrial electromechanical delay and P-wave dispersion in patients with severe mitral stenosis
2015, Indian Heart Journal
Citation Excerpt :
Percutaneous transvenous mitral commissurotomy (PTMC) is currently the treatment of choice for patients with symptomatic severe MS and favorable valve morphology. Successful PTMC leads to increase in mitral valve area (MVA), cardiac index, and decrease in transmitral diastolic pressure gradient, left atrial pressure, left atrial volume, and pulmonary artery pressures.16,17 It also leads to sustained improvement in the functional class of the patients.18,19
Mitral stenosis (MS) is associated with prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion, which are markers of atrial fibrillation (AF) risk. This study was conducted to assess the immediate effect of successful percutaneous transvenous mitral commissurotomy (PTMC) on these parameters.
This single center observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area (MVA) of 0.74 ± 0.13 cm²), in sinus rhythm, who underwent successful PTMC at our hospital. P-wave dispersion (PWD) was calculated by subtracting minimum P-wave duration (P_min) from maximum P-wave duration (P_max), measured on a 12-lead surface ECG obtained from each patient in supine position at a paper speed of 50 mm/s and 20 mm/mV. Inter-atrial (AEMD), left intra-atrial (L-IAEMD), and right intra-atrial (R-IAEMD) electromechanical delays were measured on tissue Doppler imaging. PTMC was performed using the standard Inoue Balloon technique. All these parameters were evaluated and compared before and 24–48 h after PTMC.
Successful PTMC led to significant reduction in AEMD (p < 0.001), L-IAEMD (p < 0.001), and R-IAEMD (p < 0.001). There were no changes in P_max, P_min, and PWD immediately after PTMC.
Successful PTMC has a favorable early impact on inter- and intra-atrial electromechanical delays, which are considered as novel parameters of atrial electromechanical remodeling in MS patients. Prospective large-scale studies are required to confirm whether improvement in these markers translates into reduced long-term AF risk.
Management of mitral stenosis using 2D and 3D echo-doppler imaging
2013, JACC: Cardiovascular Imaging
Although the prevalence of rheumatic fever is decreasing in developed countries, it still affects numerous areas in the nonindustrialized world. Untreated mitral stenosis (MS) contributes to a significant global morbidity and mortality. Echocardiography is the main diagnostic imaging modality with which to evaluate mitral valve (MV) obstruction and assess the severity and hemodynamic consequences of MS as well as valve morphology. According to current guidelines and recommendations for clinical practice, the severity of MS should not be defined by a single value but assessed by valve areas, mean Doppler gradients, and pulmonary pressures. Transthoracic echocardiography is usually sufficient to grade MS severity and to define the morphology of the valve. Transesophageal echocardiography is used when the valve cannot be adequately assessed with transthoracic echocardiography and to exclude intracardiac thrombi before a percutaneous or surgical intervention. Three-dimensional transthoracic and transesophageal echocardiographic assessment provide more detailed physiological and morphological information. Current definitive treatment for severe MS involves percutaneous mitral balloon valvuloplasty (PMBV) or surgery. The effectiveness of PMBV is related to the etiology of MS, and certain anatomic characteristics tend to predict a more successful outcome for PMBV, whereas other MV structural findings might suggest balloon valvuloplasty to be less likely successful or even contraindicated.

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Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy

Abstract

J Thorac Cardiovasc Surg

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Percutaneous transvenous mitral commissurotomy (PTMC): the Far East experience