Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience

Abstract

Objective: We sought to analyze short-term clinical, echocardiographic, and hemodynamic consequences of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of rheumatic mitral stenosis (MS) in our clinic. Methods: We retrospectively reviewed 53 patients (49 females, 5 males; mean age 38±11 years) who underwent PMBV for moderate or severe MS between January 2010 and October 2014. Procedural success was defined as the reaching a mitral valve area (MVA) >1.5 cm2 and absence of grade 3 mitral regurgitation. Results: We were able to perform PMBV in 48 of 53 patients (91%) and all the procedures that were completed were successful. PMBV couldn\'t be performed in 3 patients due to inability to pass the mitral valve, 1 patient due to membranous obstructive vena cava and 1 patient due inability to perform septostomi. Two patients who underwent successful PMBV became symptomatic after an average of 14 months follow-up and mitral valve replacement was performed due to moderate-to-severe MS. Patients were followed for an average of 13 ± 8 months and atrial fibrillation development or embolic complications were not observed. Conclusion: Percutaneous mitral balloon valvuloplasty procedure is a safe and effective treatment approach with high success and low complication rates in experienced centers.

Keywords

• Mitral stenosis, percutaneous mitral balloon valvuloplasty, echocardiography, mitral valve area

Perkütan mitral balon valvüloplasti kısa dönem takip sonuçları: Tek merkez deneyimi

Abstract

Amaç: Bu çalışmada kliniğimizdeki romatizmal mitral darlıklı (MD) erişkin hastalara uygulanan perkütan mitral balon valvüloplastinin (PMBV) erken dönem klinik, ekokardiyografik ve hemodinamik sonuçlarını değerlendirmeyi amaçladık. Yöntemler: Kliniğimizde Ocak 2010-Ekim 2014 tarihleri arasında orta ya da ciddi MD nedeniyle PMBV uygulanan 53 hasta (49 kadın, 5 erkek; ortalama yaş 38±11 yıl) geriye dönük olarak değerlendirildi. İşlem başarısı, işlem sonrası mitral kapak alanının (MKA) >1,5 cm2 olması ve 3. derece mitral yetersizlik (MY) olmaması olarak kabul edildi. Bulgular: Toplam 53 hastadan 48\'inde (%91) PMBV işlemi uygulanabildi ve tamamlanabilen tüm işlemler başarılı oldu. Hastalardan 3\'üne kapak geçilememesi, 1\'ine membranöz obstrüktif vena kava, 1\'ine de septostomi yapılamaması nedeniyle PMBV uygulanamadı. Başarılı PMBV uygulanan 2 hastaya ortalama 14 ay sonra semptomatik orta-ciddi MD nedeniyle mitral kapak replasmanı yapıldı. Ortalama 13±8 ay boyunca izlenen hastalarda atrial fibrilasyon gelişmesi veya embolik komplikasyonlar izlenmedi. Sonuç: Perkütan mitral balon valvüloplasti işlemi deneyimli merkezlerde yüksek başarı ve düşük komplikasyon oranları ile etkin ve güvenli bir tedavi yaklaşımıdır.

Keywords

• Mitral darlık, perkütan mitral balon valvüloplasti, ekokardiyografi, mitral kapak alanı

References

1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardi- ology/American Heart Association Task Force on Practice Guidelines. J Thoracic Cardiovasc Surg 2014;148:e1-e132.
2. Mrozowska E, Krzeminska-Pakula M, Rogowski W, et al. [Atrial fibrillation in mitral valve disease--risk factors]. Polskie Archiwum Medycyny Wewnetrznej 1999;101:45- 53.
3. Acarturk E, Usal A, Demir M, et al. Thromboembolism risk in patients with mitral stenosis. Japan Heart J 1997;38:669- 675.
4. Walston A, Peter RH, Morris JJ, et al. Clinical implications of pulmonary hypertension in mitral stenosis. Am J Cardiol 1973;32:650-655.
5. Inoue K, Owaki T, Nakamura T, et al. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. The Journal of thoracic and cardiovascular surgery 1984;87:394-402.
6. Multicenter experience with balloon mitral commissuroto- my. NHLBI Balloon Valvuloplasty Registry Report on im- mediate and 30-day follow-up results. The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry Participants. Circulation 1992;85:448-461.
7. Korkmaz S, Aksu T, Sasmaz H, et al. [Acute results of percu- taneous mitral balloon valvuloplasty]. Turk Kardiyol Dern Ars 2011;39:137-142.
8. Chen CR, Cheng TO. Percutaneous balloon mitral valvulo- plasty by the Inoue technique: a multicenter study of 4832 patients in China. Am Heart J 1995;129:1197-203.

9. Cohen DJ, Kuntz RE, Gordon SP, et al. Predictors of long- term outcome after percutaneous balloon mitral valvulo- plasty. N Engl J Med 1992;327:1329-1335.
10. Dean LS, Mickel M, Bonan R, et al. Four-year follow-up of patients undergoing percutaneous balloon mitral com- missurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry. J Am Coll Cardiol 1996;28:1452-1457.
11. Fawzy ME, Hegazy H, Shoukri M, et al. Long-term clinical and echocardiographic results after successful mitral bal- loon valvotomy and predictors of long-term outcome. Eur Heart J 2005;26:1647-1652.
12. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1-23.
13. Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echo- cardiographic variables related to outcome and the mecha- nism of dilatation. Br Heart J 1988;60:299-308.
14. Song JK, Song JM, Kang DH, et al. Restenosis and adverse clinical events after successful percutaneous mitral valvu- loplasty: immediate post-procedural mitral valve area as an important prognosticator. Eur Heart J 2009;30:1254-1262.
15. Gurkaynak F, Ozer C, Cehreli S, et al. Perkutan balon mit- ral valvuloplastinin erken ve kısa dönemlerdeki etkinliği- nin noninvaziv olarak değerlendirilmesi. Türkiye Klinikleri Kardiyoloji 1990;3:240-246.
16. San M, Bozkurt A, Usal A, ve ark. Perkutan mitral balon valvüloplasti olgularımızın erken dönem sonuçları. Gazian- tep Universitesi Tip Fakultesi Dergisi 1998;9:33-37.
17. Guray Y, Guray U, Demirkan B, et al. Effect of percuta- neous mitral balloon valvuloplasty in various age groups. Turkiye Klinikleri J Cardiovasc Sci 2006;18:103-106.