[How to predict the development of severe mitral regurgitation after percutaneous mitral commissurotomy?]

Severe mitral regurgitation after balloon mitral commissurotomy is a major complication with poor prognosis. In a series of 1200 consecutive patients who underwent percutaneous mitral valvulotomy 62 (5.2%) developed subsequent severe mitral regurgitation (MR). These patients were matched with randomly selected 62 pts who have had successful procedure. Mitral valve and subvalvular morphology was graded in both groups by means of the Wilkins score and new MR echocardiographic score. The latter takes into account distribution of thickness in anterior and posterior mitral leaflets, degree of commissural and subvalvular disease involvement, with each component graded from 1 to 4. No differences were noticed regarding the Wilkins score between pts with and without MR. MR echocardiographic score was significantly greater in MR group. The Wilkins score did not correlate significantly with the MR score. Grades for the anterior leaflet, commissures and subvalvular apparatus, were also higher in MR group. No significant differences were noted in the score for the posterior leaflet. The MR echocardiographic score was superior to widely accepted Wilkins score in prediction of development of severe MR.