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Background: Percutaneous Mitral Balloon Valvuloplasty (PMBV) is a less invasive and an alternative to surgical mitral valve repair/replacement among patients with moderate to severe mitral stenosis (MS), who have a favorable valve morphology and in the absence of left atrial thrombus or moderate to severe mitral regurgitation.
The left ventricle (LV) in MS exhibits several adaptive mechanisms to maintain adequate cardiac output.
Our aim was to evaluate the immediate effect of PMBV on left ventricular function in MS.
Methods: In this retrospective study we included 13 patients with moderate to severe MS who underwent successful PMBV without significant post procedure mitral regurgitation. LV strain using Speckle tracking technique was performed on perioperative Transesophageal Echocardiography (TEE) images. Immediate pre and post procedure LV strain was compared. Longitudinal strain was performed on mid-esophageal four-chamber view images, radial and circumferential strain was performed on trans-gastric mid-papillary short axis view images.
Results: There was a significant improvement in global longitudinal strain (GLS) immediately after a successful PMBV (-10.76± 4.73 vs.-15.08±5.02, p value-0.033) with significant change in time to peak Global longitudinal Strain Rate (TPK GLSR) in systole (0.23±0.07 vs.0.28±0.09, p value 0.0444). There was no significant immediate variation in circumferential and radial strain. There was a significant decrease in mitral valve gradient, pulmonary artery pressure associated with an increase in mitral valve area.
Conclusions: Previous studies have reported abnormal LV function in MS owing to low diastolic filling volumes that leads to reduction in stroke volume. This is compensated by an increase in heart rate to maintain adequate cardiac output. As observed in this study, the LV strain is impaired in patients with MS and had significant improvement in GLS immediately after PMBV. Our findings indicate that left ventricular dysfunction in mitral stenosis could be due to impaired LV deformation from reduced preload and improves significantly immediately after PMBV.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Novel Echocardiographic Methods for Assessing Cardiac Function
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1120-241
- 2017 American College of Cardiology Foundation