Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation.

G T Wilkins, A E Weyman, V M Abascal, P C Block and I F Palacios

Department of Medicine, Massachusetts General Hospital, Boston 02114.

Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional echocardiography before and after balloon dilatation of the mitral valve. The appearance of the mitral valve on the pre-dilatation echocardiogram was scored for leaflet mobility, leaflet thickening, subvalvar thickening, and calcification. Mitral valve area, left atrial volume, transmitral pressure difference, pulmonary artery pressure, cardiac output, cardiac rhythm, New York Heart Association functional class, age, and sex were also studied. Because there was some increase in valve area in almost all patients the results were classified as optimal or suboptimal (final valve area less than 1.0 cm2, final left atrial pressure greater than 10 mm Hg, or final valve area less than 25% greater than the initial area). The best multiple logistic regression fit was found with the total echocardiographic score alone. A high score (advanced leaflet deformity) was associated with a suboptimal outcome while a low score (a mobile valve with limited thickening) was associated with an optimal outcome. No other haemodynamic or clinical variables emerged as predictors of outcome in this analysis. Examination of pre-dilatation and post-dilatation echocardiograms showed that balloon dilatation reliably resulted in cleavage of the commissural plane and thus an increase in valve area.

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• Sutaria, N, Shaw, T R D, Prendergast, B, Northridge, D (2006). Transoesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy. Heart 92: 52-57 [Abstract] [Full Text]  
• Varma, P. K., Theodore, S., Neema, P. K., Ramachandran, P., Sivadasanpillai, H., Nair, K. K., Neelakandhan, K. S. (2005). Emergency surgery after percutaneous transmitral commissurotomy: Operative versus echocardiographic findings, mechanisms of complications, and outcomes. J. Thorac. Cardiovasc. Surg. 130: 772-776 [Abstract] [Full Text]  
• Fawzy, M. E., Hegazy, H., Shoukri, M., El Shaer, F., ElDali, A., Al-Amri, M. (2005). Long-term clinical and echocardiographic results after successful mitral balloon valvotomy and predictors of long-term outcome. Eur Heart J 26: 1647-1652 [Abstract] [Full Text]  
• Carabello, B. A. (2005). Modern Management of Mitral Stenosis. Circulation 112: 432-437 [Full Text]  
• Hillis, G. S, Bloomfield, P. (2005). Basic transthoracic echocardiography. BMJ 330: 1432-1436 [Full Text]  
• Fawzy, M E, Stefadouros, M A, Hegazy, H, Shaer, F E, Chaudhary, M A, Fadley, F A (2005). Long term clinical and echocardiographic results of mitral balloon valvotomy in children and adolescents. Heart 91: 743-748 [Abstract] [Full Text]  
• Kabukcu, M., Arslantas, E., Ates, I., Demircioglu, F., Ersel, F. (2005). Clinical, Echocardiographic, and Hemodynamic Characteristics of Rheumatic Mitral Valve Stenosis and Atrial Fibrillation. ANGIOLOGY 56: 159-163 [Abstract]  
• Souza, L. R., Pomerantzeff, P. M. A., de Almeida Brandao, C. M., Cardoso, L. F., Carrillo, L. R. V., Moreira, L. F. P., Grinberg, M., de Oliveira, S. A. (2004). Late evolution of mitral commissurotomy in patients with low echocardiographic score. Eur. J. Cardiothorac. Surg. 26: 640-645 [Abstract] [Full Text]  
• Zamorano, J., Cordeiro, P., Sugeng, L., Perez de Isla, L., Weinert, L., Macaya, C., Rodriguez, E., Lang, R. M. (2004). Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: An accurate and novel approach. J Am Coll Cardiol 43: 2091-2096 [Abstract] [Full Text]  
• Silaruks, S., Thinkhamrop, B., Kiatchoosakun, S., Wongvipaporn, C., Tatsanavivat, P. (2004). Resolution of Left Atrial Thrombus after 6 Months of Anticoagulation in Candidates for Percutaneous Transvenous Mitral Commissurotomy. ANN INTERN MED 140: 101-105 [Abstract] [Full Text]  
• Turgeman, Y., Atar, S., Rosenfeld, T. (2003). The Subvalvular Apparatus in Rheumatic Mitral Stenosis: Methods of Assessment and Therapeutic Implications. Chest 124: 1929-1936 [Abstract] [Full Text]  
• Gamra, H, Betbout, F, Ben Hamda, K, Addad, F, Maatouk, F, Dridi, Z, Hammami, S, Abdellaoui, M, Boughanmi, H, Hendiri, T, Ben Farhat, M (2003). Balloon mitral commissurotomy in juvenile rheumatic mitral stenosis: a ten-year clinical and echocardiographic actuarial results. Eur Heart J 24: 1349-1356 [Abstract] [Full Text]  
• Messika-Zeitoun, D., Fung Yiu, S., Cormier, B., Iung, B., Scott, C., Vahanian, A., Jamil Tajik, A, Enriquez-Sarano, M. (2003). Sequential assessment of mitral valve area during diastole using colour M-mode flow convergence analysis: new insights into mitral stenosis physiology. Eur Heart J 24: 1244-1253 [Abstract] [Full Text]  
• Chiang, C.-W., Hsu, L.-A., Chu, P.-H., Ho, W.-J., Lo, H.-S., Chang, C.-C. (2003). Feasibility of Simplifying Balloon Mitral Valvuloplasty by Obviating Left-Sided Cardiac Catheterization Using On-line Guidance With Transesophageal Echocardiography. Chest 123: 1957-1963 [Abstract] [Full Text]  
• Langerveld, J., van Hemel, N. M., Kelder, J. C., Ernst, J. M. P. G., Plokker, H. W. M., Jaarsma, W. (2003). Long-term follow-up of cardiac rhythm after percutaneous mitral balloon valvotomy: Does atrial fibrillation persist?. Europace 5: 47-53 [Abstract]  
• Gillinov, A. M., Cosgrove, D. M. III (2003). Mitral Valve Repair. Card Surg Adult 2: 933-950 [Full Text]  
• Mohan, J. C., Patel, A. R., Passey, R., Gupta, D., Kumar, M., Arora, R., Pandian, N. G. (2002). Is the mitral valve area flow-dependent in mitral stenosis?: A dobutamine stress echocardiographic study. J Am Coll Cardiol 40: 1809-1815 [Abstract] [Full Text]  
• Iung, B., Gohlke-Barwolf, C., Tornos, P., Tribouilloy, C., Hall, R., Butchart, E., Vahanian, A. (2002). Recommendations on the management of the asymptomatic patient with valvular heart disease. Eur Heart J 23: 1253-1266  
• Fan, K., Lee, K. L., Chow, W.-H., Chau, E., Lau, C.-P. (2002). Internal Cardioversion of Chronic Atrial Fibrillation During Percutaneous Mitral Commissurotomy: Insight Into Reversal of Chronic Stretch-Induced Atrial Remodeling. Circulation 105: 2746-2752 [Abstract] [Full Text]  
• Prendergast, B D, Shaw, T R D, Iung, B, Vahanian, A, Northridge, D B (2002). Contemporary criteria for the selection of patients for percutaneous balloon mitral valvuloplasty. Heart 87: 401-404 [Full Text]  
• Silaruks, S., Thinkhamrop, B., Tantikosum, W., Wongvipaporn, C., Tatsanavivat, P., Klungboonkrong, V. (2002). A prognostic model for predicting the disappearance of left atrial thrombi among candidates for percutaneous transvenous mitral commissurotomy. J Am Coll Cardiol 39: 886-891 [Abstract] [Full Text]  
• Wang, A., Krasuski, R. A., Warner, J. J., Pieper, K., Kisslo, K. B., Bashore, T. M., Harrison, J. K. (2002). Serial echocardiographic evaluation of restenosis after successful percutaneous mitral commissurotomy. J Am Coll Cardiol 39: 328-334 [Abstract] [Full Text]  
• Yetkin, E., Cehreli, S., ileri, M., Senen, K., Atak, R., Yanik, A., Yetkin, O., Sasmaz, H. (2001). Comparison of Clinical Echocardiographic and Hemodynamic Characteristics of Male and Female Patients who Underwent Mitral Balloon Valvuloplasty. ANGIOLOGY 52: 835-839 [Abstract]  
• de Souza, J. A. M., Martinez, E. E. Jr, Ambrose, J. A., Alves, C. M. R., Born, D., Buffolo, E., Carvalho, A. C. C. (2001). Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy. J Am Coll Cardiol 37: 900-903 [Abstract] [Full Text]  
• Hildick-Smith, D.J.R, Taylor, G.J, Shapiro, L.M (2000). Inoue balloon mitral valvuloplasty: long-term clinical and echocardiographic follow-up of a predominantly unfavourable population. Eur Heart J 21: 1690-1697 [Abstract]  
• Binder, T. M., Rosenhek, R., Porenta, G., Maurer, G., Baumgartner, H. (2000). Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography. J Am Coll Cardiol 36: 1355-1361 [Abstract] [Full Text]  
• Sutaria, N, Northridge, D B, Shaw, T R D (2000). Significance of commissural calcification on outcome of mitral balloon valvotomy. Heart 84: 398-402 [Abstract] [Full Text]  
• HILDICK-SMITH, D J R, SHAPIRO, L M (2000). Balloon mitral valvuloplasty in the elderly. Heart 83: 374-375 [Full Text]  
• Sutaria, N, Elder, A T, Shaw, T R D (2000). Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over. Heart 83: 433-438 [Abstract] [Full Text]  
• Gomez-Hospital, J. A., Cequier, A., Romero, P. V., Canete, C., Ugartemendia, C., Mauri, J., Esplugas, E. (2000). Partial Improvement in Pulmonary Function After Successful Percutaneous Balloon Mitral Valvotomy. Chest 117: 643-648 [Abstract] [Full Text]  
• Kang, D.-H., Park, S.-W., Song, J.-K., Kim, H.-S., Hong, M.-K., Kim, J.-J., Park, S.-J. (2000). Long-term clinical and echocardiographic outcome of percutaneous mitral valvuloplasty: Randomized comparison of Inoue and double-balloon techniques. J Am Coll Cardiol 35: 169-175 [Abstract] [Full Text]  
• Kwan, T., Clark, L. T., Safi, A. M. (2000). Successful Percutaneous Balloon Mitral Valvuloplasty Using Left Ventricular Pressure as a Guide to Cross the Mitral Valve: A Case Report. ANGIOLOGY 51: 83-86 [Abstract]  
• Cotrufo, M., Renzulli, A., Ismeno, G., Caruso, A., Mauro, C., Caso, P., De Simone, L., Violini, R. (1999). Percutaneous mitral commissurotomy versus open mitral commissurotomy: a comparative study. Eur. J. Cardiothorac. Surg. 15: 646-652 [Abstract] [Full Text]  
• Langerveld, J., Thijs Plokker, H.W., Ernst, S.M.P.G., Kelder, J.C., Jaarsma, W. (1999). Predictors of clinical events or restenosis during follow-up after percutaneous mitral balloon valvotomy. Eur Heart J 20: 519-526 [Abstract]  
• Cribier, A., Eltchaninoff, H., Koning, R., Rath, P. C., Arora, R., Imam, A., El-Sayed, M., Dani, S., Derumeaux, G., Benichou, J., Tron, C., Janorkar, S., Pontier, G., Letac, B. (1999). Percutaneous Mechanical Mitral Commissurotomy With a Newly Designed Metallic Valvulotome : Immediate Results of the Initial Experience in 153 Patients. Circulation 99: 793-799 [Abstract] [Full Text]  
• Stefanadis, C. I., Stratos, C. G., Lambrou, S. G., Bahl, V. K., Cokkinos, D. V., Voudris, V. A., Foussas, S. G., Tsioufis, C. P., Toutouzas, P. K. (1998). Retrograde nontransseptal balloon mitral valvuloplasty: immediate results and intermediate long-term outcome in 441 cases--a multicenter experience. J Am Coll Cardiol 32: 1009-1016 [Abstract] [Full Text]  
• Meneveau, N, Schiele, F, Seronde, M-F, Breton, V, Gupta, S, Bernard, Y, Bassand, J-P (1998). Predictors of event-free survival after percutaneous mitral commissurotomy. Heart 80: 359-364 [Abstract] [Full Text]  
• Lokhandwala, Y. Y., Banker, D., Vora, A. M., Kerkar, P. G., Deshpande, J. R., Kulkarni, H. L., Dalvi, B. V. (1998). Emergent balloon mitral valvotomy in patients presenting with cardiac arrest, cardiogenic shock or refractory pulmonary edema. J Am Coll Cardiol 32: 154-158 [Abstract] [Full Text]  
• Palacios, I. F. (1998). Farewell to Surgical Mitral Commissurotomy for Many Patients. Circulation 97: 223-226 [Full Text]  
• Farhat, M. B., Ayari, M., Maatouk, F., Betbout, F., Gamra, H., Jarrar, M., Tiss, M., Hammami, S., Thaalbi, R., Addad, F. (1998). Percutaneous Balloon Versus Surgical Closed and Open Mitral Commissurotomy : Seven-Year Follow-up Results of a Randomized Trial. Circulation 97: 245-250 [Abstract] [Full Text]  
• Carabello, B. A., Crawford, F. A. (1997). Valvular Heart Disease. NEJM 337: 32-41 [Full Text]  
• Cheitlin, M. D., Alpert, J. S., Armstrong, W. F., Aurigemma, G. P., Beller, G. A., Bierman, F. Z., Davidson, T. W., Davis, J. L., Douglas, P. S., Gillam, L. D., Lewis, R. P., Pearlman, A. S., Philbrick, J. T., Shah, P. M., Williams, R. G., Ritchie, J. L., Cheitlin, M. D., Eagle, K. A., Gardner, T. J., Garson, A. Jr, Gibbons, R. J., Lewis, R. P., O'Rourke, R. A., Ryan, T. J. (1997). ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography. Circulation 95: 1686-1744 [Full Text]  
• Orrange, S. E., Kawanishi, D. T., Lopez, B. M., Curry, S. M., Rahimtoola, S. H. (1997). Actuarial Outcome After Catheter Balloon Commissurotomy in Patients With Mitral Stenosis. Circulation 95: 382-389 [Abstract] [Full Text]  
• Suri, R. K., Pathania, R., Jha, N. K., Singh, H., Dhaliwal, R. S., Rana, S. S., Thingnam, S. K., Sarwal, V., Gujral, J. S. (1996). CLOSED MITRAL VALVOTOMY FOR MITRAL RESTENOSIS: EXPERIENCE IN 113 CONSECUTIVE CASES. J. Thorac. Cardiovasc. Surg. 112: 727-730 [Abstract] [Full Text]  
• Gilon, D., Cape, E. G., Handschumacher, M. D., Jiang, L., Sears, C., Solheim, J., Morris, E., Strobel, J. T., Miller-Jones, S. M., Weyman, A. E., Levine, R. A. (1996). Insights From Three-dimensional Echocardiographic Laser Stereolithography: Effect of Leaflet Funnel Geometry on the Coefficient of Orifice Contraction, Pressure Loss, and the Gorlin Formula in Mitral Stenosis. Circulation 94: 452-459 [Abstract] [Full Text]  
• Kaul, A., Bhattacharya, S., Borker, S., Patwardhan, A. M., Chaukar, A. P., Abhyankar, A. D. (1995). Transventricular mitral valve dilator: An improved design concept. J. Thorac. Cardiovasc. Surg. 110: 856-859 [Full Text]  
• Palacios, I. F., Tuzcu, M. E., Weyman, A. E., Newell, J. B., Block, P. C. (1995). Clinical Follow-up of Patients Undergoing Percutaneous Mitral Balloon Valvotomy. Circulation 91: 671-676 [Abstract] [Full Text]  
• Reyes, V. P., Raju, B. S., Wynne, J., Stephenson, L. W., Raju, R., Fromm, B. S., Rajagopal, P., Mehta, P., Singh, S., Rao, D. P., Satyanarayana, P.V., Turi, Z. G. (1994). Percutaneous Balloon Valvuloplasty Compared with Open Surgical Commissurotomy for Mitral Stenosis. NEJM 331: 961-967 [Abstract] [Full Text]  
• Carabello, B. A., Crawford, F. A. (1994). Therapy for Mitral Stenosis Comes Full Circle. NEJM 331: 1014-1015 [Full Text]  
• Sagie, A., Schwammenthal, E., Palacios, I. F., King, M. E., Leavitt, M., Freitas, N., Weyman, A. E., Levine, R. A. (1994). Significant tricuspid regurgitation does not resolve after percutaneous balloon mitral valvotomy. J. Thorac. Cardiovasc. Surg. 108: 727-735 [Abstract] [Full Text]  
• Palacios, I. F., Sanchez, P. L., Harrell, L. C., Weyman, A. E., Block, P. C. (2002). Which Patients Benefit From Percutaneous Mitral Balloon Valvuloplasty?: Prevalvuloplasty and Postvalvuloplasty Variables That Predict Long-Term Outcome. Circulation 105: 1465-1471 [Abstract] [Full Text]