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Significance of commissural calcification on outcome of mitral balloon valvotomy

N Sutaria1, D B Northridge, T R Shaw

  • 1Department of Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.

Heart (British Cardiac Society)
|September 20, 2000
PubMed

Insights

Commissural calcification, assessed by echocardiography, predicts mitral balloon valvotomy outcomes. Mild calcification improves valve area and symptoms in suitable patients, indicating valve replacement for severe cases.

Area of Science:

  • Cardiology
  • Echocardiography
  • Valvular Heart Disease

Background:

  • Mitral balloon valvotomy is a treatment for mitral stenosis.
  • Predicting the success of mitral balloon valvotomy is crucial for patient management.
  • Commissural calcification is a feature seen on echocardiography of the mitral valve.

Purpose of the Study:

  • To assess the impact of commissural calcification on mitral balloon valvotomy outcomes.
  • To determine if commissural calcification predicts haemodynamic and symptomatic improvement.

Main Methods:

  • Commissural calcification was graded (0-4) using transthoracic echocardiography.
  • Mitral valve morphology was assessed using the Massachusetts General Hospital echo score.
  • 300 patients (85 retrospective, 215 prospective) were studied.

Main Results:

  • Commissural calcification grade predicted achieving a mitral valve area > 1.50 cm² without severe reflux.
  • In patients with echo score ≤ 8, lower calcification grades showed significantly better valve area and symptom improvement.
  • Patients with grade 0/1 calcification had a 67% success rate vs. 46% for grade 2/3 (p < 0.05).

Conclusions:

  • Transthoracic echocardiography-assessed commissural calcification predicts outcomes in patients with "good" valves (echo score ≤ 8).
  • Calcification of one or more commissures suggests <50% probability of achieving a valve area > 1.50 cm².
  • Commissural calcification may indicate valve replacement for suitable surgical candidates.
Abstract

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