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Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease. Glob Heart 2020; 15:38. [PMID: 32923332 PMCID: PMC7427678 DOI: 10.5334/gh.807] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To estimate the incidence, prevalence, and correlates of atrial fibrillation (AF) in a global population with rheumatic heart disease (RHD). Methods: Bibliographic databases were searched to identify all published studies providing data on AF in patients with RHD. Random-effects meta-analysis method was used to pool estimates. Results: Eighty-three studies were included, reporting data from 75,637 participants with RHD in 42 countries. The global prevalence of AF in RHD was 32.8% (range: 4.3%–79.9%). It was higher in severe valvular disease (30.8% vs 20.7%, p = 0.009), in severe mitral valve disease compared to severe aortic disease (30.4% vs 6.3%, p = 0.038). The global cumulative incidence of AF in patients with RHD was 4.8%, 11.4%, 13.2%, and 30.8% at 1, 2, 5, and 10 years of follow-up, respectively. From comparison between patients with and without AF, AF was associated with increased age (mean difference [MD]: 9.5 years; 95% CI: 7.8–1.3), advanced heart failure (odds ratio [OR]: 4.4; 95% CI 2.1–9.3), tricuspid valve involvement (OR: 4.0; 95% CI: 3.0–5.3), history of thromboembolism (OR: 6.2; 95% CI: 3.4–11.4), highly sensitive C-reactive protein (MD: 5.5 mg/dL; 95% CI: 1.2–9.8), systolic pulmonary arterial pressure (MD: 3.6 mmHg; 95% CI: 0.8–6.3), right atrium pressure (MD: 1.5 mmHg; 95% CI: 1.0–2.0), and left atrium diameter (MD: 8.1 mm; 95% CI: 5.5–10.7). Conclusions: About one-third of patients with RHD have AF, with an incidence which almost triples every five years after diagnosis. Factors associated with AF include age, advanced heart failure, thromboembolism, and few cardiac hemodynamics parameters.
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Zhang L, Hou J, Duan Y, Chen J, Du H, Shi Z. Study on the long-term curative effect of repeat percutaneous balloon mitral valvuloplasty in patients with mitral restenosis. Medicine (Baltimore) 2019; 98:e16790. [PMID: 31393407 PMCID: PMC6709142 DOI: 10.1097/md.0000000000016790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To study the long-term curative effect of repeat percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral restenosis.In our study, mitral restenosis developed in 39 patients after PBMV. Repeat PBMV was performed according to the improved Inoue method. All patients were followed up.Of 39 patients, 36 were successfully treated with repeat PBMV (achievement ratio, 92.3%). Immediately after repeat PBMV, clinical symptoms and left atrial mean pressure (LAP), pulmonary artery systolic pressure (PASP), mitral valve gradient (MVG), and mitral valve orifice area (MVA) improved significantly (24.50 ± 6.54 mmHg vs 9.66 ± 4.21 mmHg for LAP, 1.05 ± 0.19 cm vs 2.23 ± 0.22 cm for MVA, 17.03 ± 4.52 mmHg vs 7.79 ± 4.07 mmHg for MVG, 58.12 ± 12.68 mmHg vs 31.45 ± 10.02 mmHg for PASP; P <.05). Meanwhile, left atrial end-diastolic dimension (LAD) was altered slightly (4.71 ± 0.75 vs 4.07 ± 0.69, P >.05). The 36 patients were followed up for 69 ± 23 (12-146) months. After long-term follow-up immediately after repeat PBMV, the results did not show a significant change (2.23 ± -0.22 cm vs 2.02 ± -0.21 cm for MVA, 7.79 ± -4.07 mmHg vs 9.15 ± -4.11 mmHg for MVG; P >.05) and were approximated to those shortly after repeat PBMV (2.23 ± 0.22 cm vs 2.02 ± 0.21 cm for MVA, 7.79 ± 4.07 mmHg vs 9.15 ± 4.11 mmHg for MVG; P > 0.05). LAD did not change significantly (4.13 ± 0.71 cm vs. 4.07 ± 0.69 cm; P >.05). The long-term follow-up results showed that cardiac function and quality of life were significantly improved in most patients.It would be safe for patients with mitral restenosis to undergo repeat PBMV. Appropriate cases should be selected, and treatment should be performed cautiously. Short- and long-term curative effects would be satisfactory. We suggested that repeat PBMV be the first choice for patients with mitral restenosis after first PBMV.
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Abstract
PURPOSE OF REVIEW This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS). RECENT FINDINGS While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented. For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.
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Liu Y, Guo GL, Wen B, Wang S, Ou-Yang WB, Xie Y, Pan XB. Feasibility and effectiveness of percutaneous balloon mitral valvuloplasty under echocardiographic guidance only. Echocardiography 2018; 35:1507-1511. [PMID: 29920758 DOI: 10.1111/echo.14055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice in patients with isolated mitral stenosis. This study aimed to assess the feasibility of PBMV under echocardiography guidance only of isolated mitral stenosis (MS). METHODS From October 2016 to Dec 2017, 20 consecutive patients with severe MS underwent PBMV with echocardiography as the only imaging modality at a single center. Outpatient follow-up including chest radiography, electrocardiography, and transthoracic echocardiography was conducted at 1, 3,6, and 12 months after the procedure. RESULTS All 20 patients successfully underwent PBMV under echocardiography guidance without radiation and contrast agent. Among them, 2 patients were pregnant, 5 had chronic renal failure, and 1 had history of allergy to contrast. Mitral transvalvular pressure gradient measured at catheterization dropped from 13.35 ± 2.85 mm Hg to 5.10 ± 1.17 mm Hg (P < .01). Mitral valve area increased from 0.82 ± 0.10 cm2 pre-PBMV to 1.88 ± 0.24 cm2 post-PBMV (P < .01). Mean balloon diameter was 26.63 ± 0.93 mm. Mild mitral regurgitation developed in 6 patients. Mean follow-up duration was 6.27 ± 3.12 months. At last follow-up, mitral valve area remained high (1.71 ± 0.14 cm2 ) and mean transmitral pressure gradient low (6.07 ± 1.03 mm Hg). No pericardial effusion or peripheral vascular complications occurred. CONCLUSION In this small experience, PBMV could be successfully performed under only echocardiography guidance and appeared safe and effective while avoiding radiation and contrast agent use.
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Affiliation(s)
- Yao Liu
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gai-Li Guo
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bin Wen
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shouzheng Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen-Bin Ou-Yang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongquan Xie
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiang-Bin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Murthy Jayanthi Sriram SN, Venkata BJ, Sadagopan T, Ramamurthy MT. Immediate, intermediate and long term clinical outcomes of percutaneous transvenous mitral commissurotomy. IJC HEART & VASCULATURE 2015; 6:66-70. [PMID: 28785629 PMCID: PMC5497171 DOI: 10.1016/j.ijcha.2015.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/27/2014] [Accepted: 01/03/2015] [Indexed: 11/29/2022]
Abstract
Introduction Percutaneous transvenous mitral commissurotomy (PTMC) is one of the nonsurgical commissurotomy in patients with hemodynamically significant mitral stenosis. The aim of the present study is to assess the immediate, intermediate and long term outcomes of PTMC in relation to initial mitral valve score and to assess its impact on mitral valve area (MVA), clinical and hemodynamic parameters. Methods It is a retrospective study on a total of 303 patients who underwent successful PTMC between 1994 and 2001, were called back and their preprocedural, immediate post and follow-up (4, 7 and 10 year.) data were analyzed. Echo was performed in patients before and after PTMC. The patients were divided into two groups, group-I with Wilkins score of ≤ 8 and group-II with Wilkins score between 8 and 12. Results PTMC patients who have completed 4, 7 and 10 years of follow up revealed the mitral valve area, mean transmitral gradient and pulmonary artery pressures to be significantly different in both group-I and group-II. At all follow-up periods group-II showed higher restenosis than group-I, but its distribution between the groups was not statistically significant (χ2 = 0.029; p = 0.986). Furthermore, losses of the MVA during different periods of follow-up revealed a gradual increase in attrition. Conclusions MV score, Mitral valve area, mitral gradient and pulmonary artery pressures appeared to influence the outcome of PTMC. A clear-cut prospective assessment of individual components of the mitral valve apparatus using 3-D echocardiographic images may provide a more precise prediction of the PTMC outcome based on its morphological abnormalities.
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Affiliation(s)
| | | | - Thanikachalam Sadagopan
- Department of Cardiology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai 600 116, India
| | - Muralidharan Thodi Ramamurthy
- Department of Cardiology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai 600 116, India
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Wunderlich NC, Beigel R, Siegel RJ. Management of Mitral Stenosis Using 2D and 3D Echo-Doppler Imaging. JACC Cardiovasc Imaging 2013; 6:1191-205. [DOI: 10.1016/j.jcmg.2013.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/03/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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Wunderlich NC, Beigel R, Siegel RJ. The role of echocardiography during mitral valve percutaneous interventions. Cardiol Clin 2013; 31:237-70. [PMID: 23743076 DOI: 10.1016/j.ccl.2013.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transesophageal echocardiography is routinely used to guide percutaneous interventions involving the mitral valve. Mitral balloon valvuloplasty for rheumatic mitral valve stenosis (MS) was the first percutaneous intervention to gain wide acceptance. New techniques have been developed to treat degenerative and functional mitral regurgitation (MR) as well as paravalvular mitral leak (PVML). This review describes the use of echocardiography for transcatheter treatment of MS, MR, and PVML.
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Nanjappa MC, Ananthakrishna R, Setty SKH, Bhat P, Shankarappa RK, Panneerselvam A, Kamalapurkar G, Bhat SP, Rao VR. Acute severe mitral regurgitation following balloon mitral valvotomy: Echocardiographic features, operative findings, and outcome in 50 surgical cases. Catheter Cardiovasc Interv 2012; 81:603-8. [DOI: 10.1002/ccd.24417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 03/12/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Manjunath C. Nanjappa
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Rajiv Ananthakrishna
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Srinivasa K. Hemanna Setty
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Prabhavathi Bhat
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | | | - Arunkumar Panneerselvam
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Giridhar Kamalapurkar
- Cardiothoracic and Vascular Surgery Department; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore; India
| | - Seetharama P.S. Bhat
- Cardiothoracic and Vascular Surgery Department; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore; India
| | - Venugopal Ram Rao
- Cardiothoracic and Vascular Surgery Department; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore; India
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Palacios IF, Arzamendi D. Percutaneous Mitral Balloon Valvuloplasty for Patients with Rheumatic Mitral Stenosis. Interv Cardiol Clin 2012; 1:45-61. [PMID: 28582067 DOI: 10.1016/j.iccl.2011.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Percutaneous balloon dilatation of stenotic cardiac valves is used for the treatment of pulmonic, mitral, aortic, and tricuspid stenosis. Percutaneous mitral balloon valvuloplasty (PMV) has been used successfully as an alternative to open or closed surgical mitral commissurotomy in the treatment of symptomatic rheumatic mitral stenosis. PMV produces good immediate hemodynamic outcome, low complication rates, and clinical improvement in the majority of patients. PMV is safe and effective and provides clinical and hemodynamic improvement in rheumatic mitral stenosis. PMV is the preferred form of therapy for relief of mitral stenosis for a selected group of patients with symptomatic mitral stenosis.
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Affiliation(s)
- Igor F Palacios
- Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Dabit Arzamendi
- Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
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Initial experience of using intracardiac echocardiography (ICE) for guiding balloon mitral valvuloplasty (BMV). J Saudi Heart Assoc 2011; 24:23-7. [PMID: 23960664 DOI: 10.1016/j.jsha.2011.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/22/2011] [Accepted: 08/01/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS BMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram (ICE) guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures. METHODS During BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography (TTE), and catheterization derived hemodynamic measurements (cath). RESULTS Seventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 ± 21 years. The mean MV area increased from 0.9 ± 0.1 cm(2) to 1.7 ± 0.2 cm(2), P < 0.0001 and the mean gradient decreased from 12.6 ± 5.8 mmHg to 4.9 ± 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath. CONCLUSION ICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath.
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Karthikeyan G, Yadav R, Narang R, Bhargava B. Does the mitral valve recoil after percutaneous balloon valvotomy? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:147-151. [DOI: 10.1016/j.carrev.2010.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 10/18/2022]
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Nair K, Sivadasanpillai H, Sivasubramonium P, Ramachandran P, Tharakan JA, Titus T, Ajit Kumar VK, Sivasubramonian S, Krishnamoorthy KM, Dora S. Percutaneous valvuloplasty for mitral valve restenosis: postballoon valvotomy patients fare better than postsurgical closed valvotomy patients. Catheter Cardiovasc Interv 2010; 76:174-80. [PMID: 20232411 DOI: 10.1002/ccd.22510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM To compare the results of percutaneous mitral valvuloplasty (BMV) for mitral restenosis in post-BMV versus postclosed mitral valvotomy (CMV) patients. METHODS AND RESULTS Ninety-two patients who underwent BMV for mitral restenosis were followed up prospectively. Of these, 28 patients had undergone previous percutaneous mitral valvuloplasty (PRIOR BMV) and 64 patients had undergone previous closed mitral valvotomy (PRIOR CMV). BMV for mitral restenosis was a success in 59% patients (57.1% PRIOR BMV, 59.3% PRIOR CMV, P = 1.0). Incidence of severe mitral regurgitation was 3.25%, all in the PRIOR CMV group. In univariate analysis, the major predictor of successful BMV for mitral restenosis was Wilkins score (P = 0.004). At a follow up of 3.47 + 2.07 years, mitral valve area was similar between groups (1.45 +/- 0.22, 1.46 +/- 0.26, P = 0.35). The combined end points of mitral valve replacement (MVR), need for re-repeat BMV for mitral restenosis or death was higher in the PRIOR CMV group (31.2% PRIOR CMV, 7.1% PRIOR BMV, P = 0.027). Event-free survival at follow up was lower in the PRIOR CMV group (69% PRIOR CMV, 92.8% PRIOR BMV) mainly due to the higher need for MVR (11 vs. 0 patients, P = 0.03). CONCLUSIONS In conclusion, following BMV for mitral restenosis, patients with PRIOR BMV are found to have lesser event rates on follow-up compared to patients with PRIOR CMV, though procedural success rates are similar.
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Affiliation(s)
- Krishnakumar Nair
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Yazıcıoğlu N, Arat Özkan A, Orta Kılıçkesmez K, Çeliker C, Mert M, Pehlivanoglu S, Enar R, Karatay C, Küçükoğlu S. Immediate and Follow-Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First Procedure. Echocardiography 2010; 27:765-9. [DOI: 10.1111/j.1540-8175.2010.01150.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Manjunath C, Srinivasa K, Ravindranath K, Manohar J, Prabhavathi B, Dattatreya P, Sridhar L, Dhanalakshmi C. Balloon mitral valvotomy in patients with mitral stenosis and left atrial thrombus. Catheter Cardiovasc Interv 2009; 74:653-61. [DOI: 10.1002/ccd.22176] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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No more surgical mitral commissurotomy, closed or open, for mitral stenosis. J Cardiol 2009; 54:169-70; author reply 170. [PMID: 19632542 DOI: 10.1016/j.jjcc.2009.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 04/17/2009] [Indexed: 11/21/2022]
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Song JK, Song JM, Kang DH, Yun SC, Park DW, Lee SW, Kim YH, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Restenosis and adverse clinical events after successful percutaneous mitral valvuloplasty: immediate post-procedural mitral valve area as an important prognosticator. Eur Heart J 2009; 30:1254-62. [PMID: 19346230 DOI: 10.1093/eurheartj/ehp096] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS We sought to investigate the factors associated with restenosis and its potential association with late clinical deterioration after successful percutaneous mitral valvuloplasty (PMV). METHODS AND RESULTS We analysed echocardiographic (median 74 months) and clinical (median 109 months) follow-up data of 329 patients who achieved procedural success, defined as mitral valve area (MVA) > or =1.5 cm(2) and mitral regurgitation (MR) < or =2/4, between 1995 and 2000. Clinical events included cardiovascular death, mitral valve surgery, and repeat PMV. The 1, 3, 5, 7, and 9 year rates of restenosis-free survival were 99 +/- 1%, 97 +/- 1%, 95 +/- 1%, 86 +/- 3%, and 72 +/- 4%, respectively. The 1, 3, 5, 7, and 9 year rates of event-free survival were 99.7 +/- 0.3%, 96.4 +/- 1.0%, 94.5 +/- 1.3%, 90.8 +/- 1.6%, and 90.0 +/- 1.7%, respectively. Immediate post-PMV MVA and commissural MR or splitting, indicators of procedural adequacy, were independent predictors of both restenosis and clinical events. The best immediate post-PMV MVA cut-off value for predicting both restenosis and clinical events within 5 years after successful PMV were 1.8 cm(2) [95% confidence interval (CI) = 1.7-1.9] and 1.9 cm(2) (95% CI = 1.7-2.0), respectively. Patients with immediate post-PMV MVA <1.8 cm(2) showed significantly lower event-free survival rate than those with post-PMV MVA > or =1.8 cm(2) (P < 0.001). CONCLUSION Immediate post-PMV MVA> or =1.8 cm(2) was an important predictor of both restenosis- and clinical event-free survival and this value should be considered as a component of optimal result.
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Affiliation(s)
- Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-ku, Seoul 138-736, South Korea.
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Cheng TO. Predicting mitral regurgitation following percutaneous mitral valvotomy with the Inoue balloon: comparison of two echocardiographic scoring systems. Clin Cardiol 2009; 23:555. [PMID: 10941538 PMCID: PMC6655244 DOI: 10.1002/clc.4960230802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Balloon Dilatation of the Cardiac Valves. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ramondo A, Napodano M, Fraccaro C, Razzolini R, Tarantini G, Iliceto S. Relation of patient age to outcome of percutaneous mitral valvuloplasty. Am J Cardiol 2006; 98:1493-500. [PMID: 17126657 DOI: 10.1016/j.amjcard.2006.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/03/2006] [Accepted: 07/03/2006] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the impact of age on immediate- and long-term outcomes of percutaneous mitral balloon valvuloplasty (PMV). PMV is the first-line treatment for patients with symptomatic mitral stenosis. However, long-term results in large series of patients from Europe and the United States have been found less favorable than those from Asia and South America involving younger patients. Six hundred ten patients who underwent 626 PMV procedures were prospectively followed for 6.1 +/- 4.10 years using clinical and echocardiographic evaluation. Patients were divided in quartiles according to age: < or =41 years (n = 163), 42 to 53 years (n = 163), 54 to 63 years (n = 142), and >63 years (n = 158). The success of PMV was defined as valve area > or =1.5 cm(2) without severe regurgitation; restenosis was defined as a loss > or =50% of initial gain, with a valve area of <1.5 cm(2). PMV success was significantly more prevalent in younger patients: 95.7% in group 1, 91.4% in group 2, 86.4% in group 3, and 83.4% in group 4 (p = 0.002). No significant differences in complications were found among all age groups, including death, cardiac tamponade, emergency mitral replacement, and any embolic events (p = NS). Event-free survival was greater in younger patients (p <0.0001), but on multivariate analysis, age was not an independent predictor of events (p = NS). Restenosis occurred in 27.9% of patients, throughout all groups (p = NS). In conclusion, PMV may be safely and effectively performed in younger and older patients. Although event-free survival was greater in younger groups, multivariate analysis did not find that age was an independent predictor of events.
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Affiliation(s)
- Angelo Ramondo
- Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Livingstone RS, Chandy S, Peace BST, George P, John B, Pati P. Audit of radiation dose during balloon mitral valvuloplasty procedure. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2006; 26:397-404. [PMID: 17146124 DOI: 10.1088/0952-4746/26/4/004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Radiation doses to patients during cardiological procedures are of concern in the present day scenario. This study was intended to audit the radiation dose imparted to patients during the balloon mitral valvuloplasty (BMV) procedure. Thirty seven patients who underwent the BMV procedure performed using two dedicated cardiovascular machines were included in the study. The radiation doses imparted to patients were measured using a dose area product (DAP) meter. The mean DAP value for patients who underwent the BMV procedure from one machine was 19.16 Gy cm(2) and from the other was 21.19 Gy cm(2). Optimisation of exposure parameters and radiation doses was possible for one machine with the use of appropriate copper filters and optimised exposure parameters, and the mean DAP value after optimisation was 9.36 Gy cm(2).
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Zimmet AD, Almeida AA, Harper RW, Smolich JJ, Goldstein J, Shardey GC, Smith JA. Predictors of Surgery After Percutaneous Mitral Valvuloplasty. Ann Thorac Surg 2006; 82:828-33. [PMID: 16928493 DOI: 10.1016/j.athoracsur.2006.03.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 03/26/2006] [Accepted: 03/29/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous mitral valvuloplasty (PMV) is a minimally invasive treatment option for selected patients with mitral stenosis (MS). In general, the procedure is well-tolerated with a high success rate. However, relatively little is known about the predictors of surgical intervention after PMV. METHODS A retrospective analysis was performed on 243 patients undergoing PMV at a single institution over a 14 year period. RESULTS Fifty (21%) of 243 patients, comprising 44 women and 6 men and aged 55 +/- 14 years, underwent cardiac surgery at a median interval of 6 months (range, 0 to 130) after PMV. Nine (18%) underwent a procedure within 15 days, and 41 (82%) had a procedure more than 15 days after the valvuloplasty. After PMV, surgery-free survival was 85% at 1 year, 83% at 2 years, 81% at 3 years, 80% at 4 years, and 80% at 5 years. CONCLUSIONS The need for surgery after PMV is not uncommon. Independent predictors of surgery after PMV included severity of mitral regurgitation (p < 0.003) and a higher echo score (p < 0.039).
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Affiliation(s)
- Adam D Zimmet
- Cardiothoracic Surgery Unit, Monash Medical Center, Clayton, Victoria, Australia
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Cheng TO. Patients with mild mitral stenosis vs. mildly symptomatic patients with severe mitral stenosis: an important distinction. Catheter Cardiovasc Interv 2006; 67:326. [PMID: 16400669 DOI: 10.1002/ccd.20594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Harikrishnan S, Nair K, Tharakan JM, Titus T, Kumar VKA, Sivasankaran S. Percutaneous transmitral commissurotomy in juvenile mitral stenosis—comparison of long term results of Inoue balloon technique and metallic commissurotomy. Catheter Cardiovasc Interv 2006; 67:453-9. [PMID: 16489558 DOI: 10.1002/ccd.20666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare the immediate and long term results of percutaneous mitral valvotomy using metallic commissurotome and Inoue balloon in juvenile mitral stenosis. BACKGROUND Inoue balloon technique for mitral commissurotomy (IBMC) is well established and carried out worldwide in the treatment of juvenile mitral stenosis. Percutaneous mitral metallic commissurotomy (PMMC) is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. METHODS Thirty-three patients aged less than 20 years, who underwent PMMC, were compared with 33 age and sex matched control patients who underwent IBMC. Success of valvotomy, procedure related complications, and follow-up events of the two techniques were compared. RESULTS Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups, 31/33. Complications like cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups. On follow-up of more than 3 years, both groups had comparable hemodynamic parameters and restenosis rates. CONCLUSIONS Both IBMC and PMMC are successful in providing relief from severe juvenile mitral stenosis in terms of gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success and complication rates. The long term follow-up results are comparable at follow-up of more than 3 years.
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Affiliation(s)
- S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
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Cheng TO. Mechanism of spontaneous diminution of mitral regurgitation following percutaneous mitral valvuloplasty with the Inoue balloon. Int J Cardiol 2004; 93:329. [PMID: 14975575 DOI: 10.1016/s0167-5273(03)00171-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2003] [Accepted: 03/12/2003] [Indexed: 11/25/2022]
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Chiang CW, Hsu LA, Chu PH, Ho WJ, Lo HS, Chang CC. Feasibility of simplifying balloon mitral valvuloplasty by obviating left-sided cardiac catheterization using on-line guidance with transesophageal echocardiography. Chest 2003; 123:1957-63. [PMID: 12796174 DOI: 10.1378/chest.123.6.1957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The purpose of this study was to evaluate the feasibility of simplifying balloon mitral valvuloplasty through the obviation of left-sided cardiac catheterization using on-line guidance with transesophageal echocardiography in patients with mitral stenosis. SETTING A tertiary care medical center DESIGN Patients who were eligible for balloon mitral valvuloplasty were enrolled into the study if they had no evidence of ischemic heart disease. Sixty-six patients (50 women and 16 men) met the criteria. Balloon mitral valvuloplasty was performed through right-sided cardiac catheterization using adjunctive on-line guidance with transesophageal echocardiography. Left-sided catheterization was obviated. MEASUREMENT AND RESULTS Balloon mitral valvuloplasty was smoothly performed in all patients. Successful dilatation (postprocedural mitral orifice area, > 1.5 cm(2); or increment in mitral orifice area, >or= 50%) was achieved in 50 patients (75.8%). The mean (+/- SD) mitral orifice area increased from 1.08 +/- 0.23 cm(2) to 1.68 +/- 0.39 cm(2) (p = 0.0000). There were no in-hospital deaths, no patients with cardiac tamponade, or complications necessitating an emergency cardiac operation. The mean fluoroscopy time was 7.6 +/- 3.9 min, and the total procedure time was 50.2 +/- 15.0 min. CONCLUSION It is feasible and safe to simplify balloon mitral valvuloplasty by obviating left-sided cardiac catheterization in selected patients with mitral stenosis using adjunctive on-line guidance with transesophageal echocardiography.
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Affiliation(s)
- Cheng-Wen Chiang
- Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, Republic of China.
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Bhat A, Harikrishnan S, Tharakan JM, Titus T, Kumar VKA, Sivasankaran S, Bimal F, Krishnamoorthy KM. Comparison of percutaneous transmitral commissurotomy with Inoue balloon technique and metallic commissurotomy: immediate and short-term follow-up results of a randomized study. Am Heart J 2002; 144:1074-80. [PMID: 12486433 DOI: 10.1067/mhj.2002.125621] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Inoue balloon technique for mitral commissurotomy is well established and carried out worldwide. Metallic commissurotomy is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. METHODS One hundred patients were randomized into 2 groups to undergo percutaneous transmitral commissurotomy (PTMC) by means of the Inoue balloon technique (IBMC, n = 49) or metallic commissurotomy (PMMC, n = 51). Patients were crossed over to the other technique when the initial technique was a failure. Success of valvotomy, procedure-related complications, and follow-up events of the 2 techniques were compared. RESULTS Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups: 45 of 49 procedures (91.8%) in the IBMC group, compared with 46 of 51 procedures (90.18%) in the PMMC group (P = 1.0). Crossover was also comparable, with 1 occurring in the IBMC group, compared with 3 in the PMMC group. Complications such as cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups, with 3 complications in the IBMC group, compared with 4 complications in the PMMC group (P =.29). After a follow-up period of approximately 4 months, both groups had similar event rates and comparable hemodynamic parameters (P = not significant). CONCLUSIONS Both IBMC and PMMC are successful means of providing relief from severe mitral stenosis with a gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success, complication rates, and follow-up events.
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Affiliation(s)
- Anil Bhat
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Cheng TO. Long-term results of percutaneous balloon mitral valvuloplasty with the Inoue balloon catheter in elderly patients. Am J Cardiol 2002; 90:686-7. [PMID: 12231112 DOI: 10.1016/s0002-9149(02)02735-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002; 105:1465-71. [PMID: 11914256 DOI: 10.1161/01.cir.0000012143.27196.f4] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous mitral balloon valvuloplasty (PMV) results in good immediate results, particularly in patients with echocardiographic scores (Echo-Sc) < or =8. However, which variables relate to long-term outcome is unclear. METHODS AND RESULTS We report the immediate and long-term clinical follow-up (mean, 4.2+/-3.7 years; range, 0.5 to 15) of 879 patients who underwent 939 PMV procedures. Patients were divided into 2 groups, Echo-Sc < or =8 (n=601) and Echo-Sc >8 (n=278). PMV resulted in an increase in mitral valve area from 1.0+/-0.3 to 2.0+/-0.6 cm2 in patients with Echo-Sc < or =8 and from 0.8+/-0.3 to 1.6+/-0.6 cm2 in patients with Echo-Sc >8 (P<0.0001). Although adverse events (death, mitral valve surgery, and redo PMV) were low within the first 5 years of follow-up, a progressive number of events occurred beyond this period. Nevertheless, survival (82% versus 57%) and event-free survival (38% versus 22%) at 12-year follow-up was greater in patients with Echo-Sc < or =8 (P<0.0001). Cox regression analysis identified post-PMV mitral regurgitation > or =3+, Echo-Sc >8, age, prior surgical commissurotomy, NYHA functional class IV, pre-PMV mitral regurgitation > or =2+, and higher post-PMV pulmonary artery pressure as independent predictors of combined events at long-term follow-up. CONCLUSIONS The immediate and long-term outcome of patients undergoing PMV is multifactorial. The use of the Echo-Sc in conjunction with other clinical and morphological predictors of PMV outcome allows identification of patients who will obtain the best outcome from PMV.
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Affiliation(s)
- Igor F Palacios
- Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA.
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VAHANIAN ALEC, IUNG BERNARD, CORMIER BERTRAND, MAKITA YASUHIRO, LUXEREAU PHILIPPE. Long-Term Results After Percutaneous Balloon Mitral Commissurotomy. J Interv Cardiol 2000. [DOI: 10.1111/j.1540-8183.2000.tb00303.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sutaria N, Elder AT, Shaw TR. Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over. Heart 2000; 83:433-8. [PMID: 10722546 PMCID: PMC1729359 DOI: 10.1136/heart.83.4.433] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the immediate haemodynamic improvement and long term symptomatic benefit of percutaneous mitral balloon valvotomy in patients aged over 70 years. DESIGN Pre- and postprocedure haemodynamic data and follow up for 1 to 10 years by clinic visit or telephone contact. SETTING Tertiary referral centre in Scotland. SUBJECTS 80 patients age 70 and over who had mitral balloon dilatation: 55 were considered unsuitable for surgical treatment because of frailty or associated disease. In an additional four patients mitral dilatation was not achieved. MAIN OUTCOME MEASURES Increase in valve area after balloon dilatation and survival, freedom from valve replacement, and symptom class at follow up. RESULTS Mean (SD) valve area increased by 89% from 0.84 (0.28) to 1. 59 (0.67) cm(2). There was a low rate of serious complications, with only two patients having long term major sequelae. Of 55 patients unsuitable for surgical treatment, 28 (51%) were alive without valve replacement and with improvement by at least one symptom class at one year, and 14 (25%) at five years. In the 25 patients considered suitable for surgical treatment, 16 (64%) achieved this outcome at one year and nine (36%) at five years. CONCLUSIONS Percutaneous mitral balloon valvotomy is a safe and useful palliative procedure in elderly patients who are unsuitable for surgery. Balloon dilatation should also be used for elderly patients whose valve appears suitable for improvement by commissurotomy, but echo score is an imperfect predictor of haemodynamic improvement.
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Affiliation(s)
- N Sutaria
- Department of Cardiology, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
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Cheng TO. Long-term results of percutaneous balloon mitral valvuloplasty using the Inoue balloon catheter technique. Circulation 2000; 101:E91. [PMID: 10694541 DOI: 10.1161/01.cir.101.8.e91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T O Cheng
- The George Washington University, Washington, DC, USA
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Abstract
Definitive percutaneous treatment of a patient with Lutembacher's syndrome was successfully accomplished using the Amplatzer septal occluder to close a secundum atrial septal defect and the Joseph mitral balloon catheter to dilate rheumatic mitral valve stenosis. Transcatheter therapy is an effective alternative to surgery in selected patients with Lutembacher's syndrome. Cathet. Cardiovasc. Intervent. 48:199-204, 1999.
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Affiliation(s)
- G Joseph
- Department of Cardiology, Christian Medical College Hospital, Vellore, India.
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Cheng TO. Coexistent atrial septal defect and mitral stenosis (Lutembacher syndrome): An ideal combination for percutaneous treatment. Catheter Cardiovasc Interv 1999; 48:205-6. [PMID: 10506781 DOI: 10.1002/(sici)1522-726x(199910)48:2<205::aid-ccd18>3.0.co;2-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fassbender D, Schmidt HK, Seggewiss H, Mannebach H, Bogunovic N. [Diagnosis and differential therapy of mitral stenosis]. Herz 1998; 23:420-8. [PMID: 9859036 DOI: 10.1007/bf03043402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Clinical symptoms and diagnostic findings in patients with mitral stenosis are usually determined by the extent of the stenosis. Compared to a normal mitral valve area (MVA) of > 4 cm2, MVA in patients with severe mitral stenosis is usually reduced to < 1.5 cm2. In older patients symptoms are frequently influenced by concomitant diseases (e.g. atrial fibrillation, arterial hypertension or lung disease). An important diagnostic element besides anamnesis, auscultation, ECG and chest X-ray is echocardiography, which is required in order to measure non-invasively and reliably the mitral valve gradient (MVG), the MVA and morphologic changes to the valves, as well as concomitant valvular disease, ventricular functions and, where appropriate, left-atrial thrombi. In addition to the surgical treatment of patients with severe mitral stenosis, which has been an established procedure for 50 years, percutaneous balloon mitral valvuloplasty (MVP) has recently established itself as an alternative option. At the current time, the Inoue technique seems to display the most advantages. Following transseptal puncture, the Inoue balloon is guided transvenously into the left atrium and then into the left ventricle using a special support wire. The balloon is short and soft. Its special unfolding character enables it to be placed securely in the mitral valve without any risk of ventricular perforation (Figure 1). As with surgical commissurotomy, balloon valvuloplasty leads to a separation of fused commissures. This results in a significant reduction of MVG, accompanied by an increase in the MVA (Figure 2). The results and success of MVP are influenced by the morphology of the valves and the changes to the subvalvular apparatus. In randomized studies, the results of surgical commissurotomy were comparable with those of balloon mitral valvulotomy. In our hospital, an increase in MVA from 1.0 to 1.8 cm2 could be achieved in 899 patients (mean age 56 +/- 3 years). In younger patients with less significantly changed valves, the results were correspondingly more favorable than in older patients (Figure 3). Provided valve morphology is suitable, a relapse following previous surgical commissurotomy is not a contraindication for MVP. The MVP complication rate is very low in skilled hands: mortality is below 1%; mitral insufficiency occurs in 3 to 10% of interventions; we observed a severe mitral insufficiency in 5% of our patient group. Thromboembolic complications may be prevented after exclusion of atrial thrombi by transesophageal echocardiography. The occurrence of a hemodynamically significant atrial septum defect is a very rare event. The mid-term results (5 to 10 years) and the low restenosis rate following MVP in patients with suitable valves are comparable with those of surgical commissurotomy. In older patients with considerably changed, calcified and fibrotic valves, restenosis may be expected within 1 to 5 years. In these patients MVP represents no more than a palliative intervention in order to prolong the point of surgery, for example in patients where a concomitant aortic valve disease in itself is not yet an indication for surgery. Special indications are to be found in young patients with severe mitral stenosis yet few symptoms, in pregnant females and in emergency situations, as well as in patients with Grade II mitral stenosis with intermittent atrial fibrillation. Catheter therapy is much less invasive than surgery. In case of failure the patient still has the option of surgical therapy. Patients with morphologically significantly altered valves usually receive a valve replacement since an unsuccessful reconstruction would lead to a second operation within a very short time interval. Contraindications for MVP are thrombi in the left atrium, a previously existing > Grade II mitral regurgitation and marked, degenerative destruction of the subvalvular apparatus or extensive calcification of the valves. MVP thus represents a significant addi
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Affiliation(s)
- D Fassbender
- Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhruniversität Bochum, Bad Oeynhausen
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Cheng TO. Percutaneous balloon mitral valvuloplasty with Inoue balloon is applicable to all age groups. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:412. [PMID: 9554767 DOI: 10.1002/(sici)1097-0304(199804)43:4<412::aid-ccd11>3.0.co;2-l] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Herrmann HC. Complications and long-term results of percutaneous balloon valvuloplasty for mitral stenosis. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:140. [PMID: 9488543 DOI: 10.1002/(sici)1097-0304(199802)43:2<140::aid-ccd6>3.0.co;2-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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