Author + information
- Received January 5, 1989
- Revision received December 6, 1989
- Accepted December 13, 1989
- Published online May 1, 1990.
- ↵*Address for reprints: Igor F. Palacios, MD, Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
Percutaneous mitral balloon valvuloplasty was performed in 150 patients. There were 124 women and 26 men (mean age 53 ± 1 years). A left to right shunt through the created atrial communication was present in 28 patients (19%) after valvuloplasty. The pulmonary to systemic flow ratio was s2:l in 4 patients and ≥2:1 in 24. Univariate predictors of left to right shunting after valvuloplasty included older age (p < 0.01), lower cardiac output before mitral valvuloplasty (p < 0.01), higher New York Heart Association functional class before valvuloplasty (p < 0.05), presence of mitral valve calcification under fluoroscopy (p < 0.01) and higher echocardiography score (p < 0.05). Multiple stepwise logistic regression analysis identified the presence of mitral valve calcification (p < 0.02) and lower cardiac output (p < 0.02) as the independent predictors of a left to right shunt through the atrial communication after balloon valvuloplasty.
Follow-up (10 ± 1 months) of patients with an atrial septal defect after valvuloplasty showed that 1) 6 patients died (3 in the hospital and 3 at 2, 16 and 18 months, respectively, after valvuloplasty); 2) an atrial septal defect was demonstrated in 3 of 6 patients who underwent mitral valve replacement (6 ± 0.8 months after valvuloplasty); and 3) 13 patients were in functional class 1,2 patients were in class II and 1 patient was in class III at 13 ± 1 months after valvuloplasty. A persistent atrial septal defect was demonstrated by oximetry in only S of 13 patients who underwent elective right heart catheterization at 11 ± 1 months after mitral valvuloplasty. Doppler color flow echocardiography demonstrated a left to right shunt in only one of the remaining three patients who did not undergo catheterization. Thus, 13 (59%) of 22 patients who had a left to right shunt after mitral balloon valvuloplasty were demonstrated to have no evidence of a left to right shunt through the created atrial communication at follow-up study.
- Received January 5, 1989.
- Revision received December 6, 1989.
- Accepted December 13, 1989.
- American College of Cardiology Foundation