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Predictors, mechanisms and outcome of severe mitral regurgitation complicating percutaneous mitral valvotomy with the
R Hernandez1, C Macaya, C Bañuelos
1Cardiopulmonary Department, Hospital Universitario San Carlos, Madrid, Spain.
Abstract:
During 241 consecutive percutaneous mitral valvotomy (PMV) procedures performed with the Inoue balloon, 16 patients (6.6%) developed severe mitral regurgitation (MR). Baseline clinical, echocardiographic (Doppler mitral valve area and Wilkins' score) and hemodynamic data were not different from those of patients without this complication. Severe MR occurred during the first inflation in 7 patients and after several stepwise inflations in 9. Although maximal balloon size was similar in both groups, unusual indentations and subvalvular inflations were more frequently observed in patients who developed severe MR. Early mitral valve replacement was required in 6 patients. All of them had a leaflet rupture either along the midportion (2 patients), along a commissure (4 patients), or both. Commissural calcium was present in 5 valves and 5 also had severe subvalvular involvement that had been underestimated by echocardiography. Of the 10 nonsurgically treated patients, 4 had chordal rupture by echocardiographic criteria, whereas in the remaining 6 the precise mechanism of MR could not be determined. During follow-up (11.4 +/- 4 months, range 1 to 30), 1 patient required surgery for symptoms and the remaining 9 were symptomatically improved and free of left ventricular dilatation. In conclusion, severe MR complicated 6.6% of PMV procedures with the Inoue balloon, and its mechanism was leaflet or chordal rupture. Although one third of the patients required early mitral surgery, most of the remaining obtained midterm symptomatic benefit.
Insights
Severe mitral regurgitation (MR) complicates 6.6% of Inoue balloon percutaneous mitral valvotomy (PMV) procedures. Leaflet or chordal rupture caused MR, often requiring surgery, though most patients improved symptomatically.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous mitral valvotomy (PMV) using the Inoue balloon is a common procedure.
- Severe mitral regurgitation (MR) is a potential complication of PMV.
Purpose of the Study:
- To investigate the incidence, mechanism, and outcomes of severe MR following Inoue balloon PMV.
Main Methods:
- Analysis of 241 consecutive PMV procedures.
- Comparison of baseline data between patients with and without severe MR.
- Assessment of intraprocedural findings and post-procedural outcomes.
Main Results:
- 16 patients (6.6%) developed severe MR.
- Leaflet or chordal rupture was the primary mechanism of severe MR.
- Early mitral valve replacement was needed in 6 patients due to leaflet rupture.
- Subvalvular involvement was often underestimated by echocardiography.
Conclusions:
- Severe MR is a significant complication of Inoue balloon PMV, primarily caused by leaflet or chordal rupture.
- While one-third of affected patients required early surgery, most experienced midterm symptomatic improvement.