Author + information
- Received October 31, 1985
- Revision received January 27, 1986
- Accepted January 29, 1986
- Published online June 1, 1986.
- Raymond G. McKay, MDa,
- James E. Lock, MD, FACCa,
- John F. Keane, MD,
- Robert D. Safian, MD,
- Julian M. Aroesty, MD, FACC and
- William Grossman, MD, FACC
- ↵aAddress for reprints: Raymond G. McKay, MD, Cardiovascular Division, Beth Israel Hospital, 330 Brookline Avenue, Boston, Massachusetts 02215.
A 75 year old man with long-standing rheumatic mitral stenosis who refused surgical intervention was treated with percutaneous balloon valvuloplasty. Prevalvuloplasty evaluation revealed a heavily calcified mitral valve, a mean transvalvular gradient of 18 mm Hg, a Fick cardiac index of 1.7 liters/min per m2, a mitral valve area of 0.6 cm2and 1+ mitral regurgitation. After transseptal catheterization and balloon dilation of the interatrial septum with an 8 mm angioplasty balloon, a 25 mm valvuloplasty balloon was advanced over a guide wire across the interatrial septum and positioned across the mitral anulus. Subsequent balloon inflation at 3 atm pressure resulted in a reduction of the mean mitral valve gradient to 12 mm Hg, an increase in cardiac index to 2.5 liters/min per m2, an increase in mitral valve area in 1.4 cm2and an increase in mitral regurgitation from 1+ to 2+. Valvuloplasty was well tolerated without embolization of clot or valvular debris, and resulted in marked clinical improvement with decreased dyspnea and increased exercise tolerance.
Repeat catheterization 2 months after valvuloplasty showed further resolution of pulmonary hypertension and no evidence of valvular restenosis or worsening mitral regurgitation, but detected a small atrial septal defect with a pulmonary to systemic blood flow ratio of 1.8. It is concluded that percutaneous valvuloplasty is possible in the adult patient with calcific rheumatic mitral stenosis, and may result in a significant improvement in valvular function without producing life-threatening complications.
↵b Dr. Lock is an established Investigator of the American Heart Association.
This study was supported in part by Research Training Grant HL07394 from the United States Public Health Service, Washington, DC.
- Received October 31, 1985.
- Revision received January 27, 1986.
- Accepted January 29, 1986.
- American College of Cardiology Foundation