Author + information
- Received December 23, 1987
- Revision received January 12, 1988
- Accepted May 4, 1988
- Published online January 1, 1988.
- Vivian M. Abascal, MD,
- Gerard T. Wilkins, MBChB1,
- Christopher Y. Choong, MBBChir, PhD2,
- James D. Thomas, MD3,
- Igor F. Palacios, MD, FACC,
- Peter C. Block, MD, FACC and
- Arthur E. Weyman, MD, FACCa
- ↵aAddress for reprints: Arthur E. Weyman, MD, Cardiac Ultrasound Laboratory, Phillips House, Level 8, Massachusetts General Hospital, Boston, Massachusetts 02114.
Although beneficial results have been reported immediately after percutaneous mitral balloon valvuloplasty, little information is available concerning the longer-term outcome of this procedure. The anatomic and functional results of percutaneous mitral valvuloplasty were assessed in 20 patients, in whom two-dimensional and Doppler echocardiographic examination could be obtained both immediately and 6 to 11 months (mean 7.5 ± 2.0) after balloon dilation. Mean valve area measured by planimetry decreased slightly but significantly from 1.90 ± 0.59 cm2immediately after valvuloplasty to 1.62 ± 0.55 cm2(p < 0.001) at follow-up. Individual changes in valve area were variable, and in four patients valve area decreased by >25%. Echocardiographic scores of valvular morphology were obtained by assigning scores of 0 to 4 (with increasing abnormality) to each of four morphologic characteristics of the valve, namely, leaflet mobility, thickening, calcification and subvalvular thickening. This score was higher in the four patients with a decrease in valve area >25% at follow-up than in the other patients (11 ± 2 versus 7 ± 2, p < 0.002).
Multiple regression analysis of several hemodynamic and echocardiographic factors identify first the echocardiographic score and second the valve area postvalvuloplasty as the only significant predictors of the percent decrease in valve area (r = 0.70, p < 0.006). Mitral regurgitation graded by pulsed Doppler ultrasound decreased from 1.9 ± 1.2 immediately after valvuloplasty to 1.0 ± 0.9 (p < 0.003) at follow-up, whereas there was no change in mean transmitral pressure gradient by Doppler echocardiography (5 ± 2 versus 6 ± 3 mm Hg, p = NS) and left atrial volume (74 ± 34 versus 72 ± 27 cm3, p = NS).
Thus, 6 to 11 months after balloon mitral valvuloplasty, mean mitral valve area decreases slightly. Individual changes in valve area, however, are variable. Valvular morphology assessed by two-dimensional echocardiography may be useful for identifying those patients who have an increased likelihood of developing valvular restenosis.
- Received December 23, 1987.
- Revision received January 12, 1988.
- Accepted May 4, 1988.
- American College of Cardiology