Interventional cardiology surgery
Significance of commissural calcification on outcome of mitral
balloon valvotomy
N Sutaria, D B Northridge, T R D Shaw
Department of
Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4
2XU, UK
Correspondence to: Dr Shaw trdshaw{at}ed.ac.uk
Accepted 23 March 2000
OBJECTIVE
To evaluate the
significance of commissural calcification, identified by transthoracic
echocardiography, on the haemodynamic and symptomatic outcome of mitral
balloon valvotomy.
METHODSCommissural calcification was
graded from 0-4 using parasternal short axis transthoracic views. The
morphology of the mitral valve was also assessed using the
Massachusetts General Hospital echo score.
SETTINGA tertiary cardiac centre in Scotland.
PATIENTS300 patients were studied,
85 retrospectively and 215 prospectively. Mean (SD) age was 59.8 (12.7)
years, range 13 to 87; 30% had been judged unsuitable for surgery.
Median echo score was 6.8 (3.0), range 2-16.
MAIN OUTCOME MEASURESImmediate
increase in mitral valve area and in New York Heart Association
functional class 1-3 months after balloon valvotomy.
RESULTSOn univariate and
multivariate analysis, commissural calcification grade was a
significant predictor of achieving a mitral valve area of
> 1.50 cm2 without severe mitral reflux. Its influence
was greatest in patients with an echo score 
8: those with
commissural calcification grade 0/1 had significantly greater
improvement in valve area and symptom status than those with grade 2/3;
the proportions of patients achieving a final valve area of
> 1.50 cm2 were 67% and 46%, respectively
(p < 0.05). In patients with an echo score of > 8, the influence
of commissural calcification was smaller and not significant.
CONCLUSIONSCommissural calcification
as assessed by transthoracic echocardiography is a useful predictor of
outcome in patients with otherwise "good" valves (echo score
8). Calcification of one commissure or more predicts a less than
50% probability of achieving a valve area above 1.50 cm2
and is an indication for valve replacement in those who are suitable for surgery.
Keywords: mitral balloon valvotomy; commissure calcification
© 2000 by Heart
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