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[Conventional and color Doppler echocardiography in mitral balloon valvotomy]
J L Rodrigo1, A Aubele, F Alfonso
1Departamento de Exploración Cardiopulmonar, Hospital Universitario San Carlos, Madrid.
Insights
Color Doppler echocardiography is valuable for assessing percutaneous mitral valvotomy success, detecting mitral regurgitation, and monitoring atrial septal defects during follow-up.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Percutaneous mitral valvotomy (PMV) is a procedure to treat mitral stenosis.
- Assessing the efficacy and complications of PMV requires precise imaging techniques.
Purpose of the Study:
- To evaluate the utility of conventional echocardiography, Doppler, and color Doppler in the assessment and follow-up of PMV.
- To determine the predictive value of specific Doppler parameters for procedural success.
Main Methods:
- Prospective study of 100 patients undergoing PMV.
- Utilized conventional echocardiography, Doppler, and color Doppler for assessment during and after the procedure.
- Follow-up at 1, 6, and 12 months.
Main Results:
- PMV increased mitral valve area and decreased pulmonary artery pressure.
- Transient decrease in left ventricular ejection fraction observed post-procedure.
- Color Doppler identified significant mitral regurgitation in 4% and moderate in 17% of patients.
- Increased aliasing width >29% predicted successful PMV (final area >1.5 cm²) with 80% sensitivity and 94% specificity.
- Atrial septal defects were detected in 77% of patients immediately post-dilation, with persistent shunts in one-third at one year.
Conclusions:
- Color Doppler echocardiography is essential for real-time assessment of valve area changes during PMV.
- It effectively detects and quantifies induced mitral regurgitation and facilitates non-invasive follow-up of atrial shunts.
Abstract:
With the aim of assessing the value of conventional echocardiography and Doppler and colour Doppler during and in the follow-up of percutaneous mitral valvotomy we have studied prospectively 100 consecutive patients with 1 (90%), 6 (69%) and 12 (53%) months follow-up. Age was 50 years and 80% were women. The single balloon technique was used in 68%, mitral valve area increased from 0.9 +/- 0.2 to 1.8 +/- 0.3 cm2 and decrease in pulmonary artery pressure was 10 +/- 0.05 mmHg. We found that: 1) percutaneous mitral valvotomy produced and acute and transient decrease in left ventricular ejection fraction (pre 69 +/- 9%, post 61 +/- 10% p less than 0.001; 1 month 70 +/- 10; 2) a severe mitral regurgitation appeared in 4% of patients and 17% of patients had a moderate degree of regurgitation after valvotomy; 3) after valvular dilation an increase in the width of the aliasing greater than 29% predicted a successful procedure (final area greater than 1.5 cm2) with a sensibility 80% and specificity 94%, and 4) colour Doppler detected an atrial septal defect immediately after valvular dilation in 77% of patients, and permitted non invasive follow-up of the left to right shunt. At one year a left to right shunt at the atrial level persisted roughly in 1/3 of patients. We conclude that colour Doppler Echocardiography during percutaneous mitral valvotomy is useful for a rapid assessment of the increase in valve area, the detection and quantification of mitral regurgitation induced by valvular dilation and the follow-up in these patients.