Percutaneous mitral balloon valvuloplasty: beyond classic indications

Abstract

Background and aim:

In patients with mitral stenosis (MS) percutaneous mitral balloon valvuloplasty (PMBV) is used to im-prove symptoms and prognosis. Although there is some evidence for potential long-term benefits from PMBV in asymptomatic patients with mitral valve area (MVA) between 1.0 and 1.5 cm2, there are no follow-up data on patients with symptomatic MS with MVA > 1.5 cm2, who underwent PMBV.

Methods:

We retrospectively analysed periprocedural results of 113 symptomatic patients who underwent PMBV for MS with MVA > 1.5 cm2 (group 1) and compared them with a control group of patients with MVA ≤ 1.5 cm2 (group 2). Clinical and procedural variables were compared between groups.

Results:

In group 1, PMBV resulted in a significant increase of MVA as well as a decrease of mean and maximal mitral gradients and mean left atrial pressure (LAP), and a subsequent decrease of mean and systolic pulmonary artery pressures (PAPs). Moreover, 6.3% of patients developed moderate to severe (3+) or severe (4+) post-procedural mitral regurgitation (MR). Post-procedural increase in MVA and decrease of LAP were more pronounced in group 2 than group 1 (∆MVA 0.74 cm2 vs. 0.41 cm2, p < 0.05, and ∆LAP 8.2 mmHg vs. 6.0 mmHg, p < 0.05). Nonetheless, no significant differences were observed for ∆ of mean and systolic PAPs. The grade of post-procedural MR was comparable between groups.

Conclusions: PMBV is a feasible procedure in highly selected patients without classic echocardiographic indications. None-theless, it is associated with a small but non-negligible periprocedural risk of developing severe MR.