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Percutaneous transarterial balloon mitral valvuloplasty: 30 months experience
U U Babic1, P Pejcic, Z Djurisic
1Cardiovascular Center Dragisa Misovic, Beograd/Yugoslavia.
Abstract:
Between February, 1985, and August, 1987, 76 patients with mitral stenosis underwent percutaneous transarterial mitral balloon valvuloplasty (MVP). There were 58 females and 18 males aged from 15 to 69 years (mean 39 +/- 11). In 31 patients the mitral valve was pliable (40%) and in 45 patients (60%) the valve was nonpliable. Calcified mitral stenosis was found in 24 patients (31%). Transseptal catheterization was used to place one or two 0.035" (350 cm long) exchange wires into the ascending aorta in order to be snared, retrieved and exteriorized, each one through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for mitral dilation. Single (25 mm in diameter, trefoil 3 x 12 mm, bifoil 2 x 19 mm) and double (18 and 15 mm, 18 and 18 mm, 18 and 20 mm) balloons were used in 24 and 52 patients respectively. Transarterial mitral valvuloplasty produced immediate improvement of mitral valve area (MVA = 1.1 +/- 0.3 to 2.4 +/- 0.4 cm2, p less than 0.001), mitral valve gradient (19 +/- 4 to 8 +/- 6 mmHg, p less than 0.001), echocardiographic left atrial diameter (LAD = 58 +/- 6 to 54 +/- 5 mm, p greater than 0.05) and echo-MVA (0.9 +/- 0.4 to 2.1 +/- 0.7, p less than 0.001). In three patients no MVA enlargement was achieved. A significant mitral regurgitation was produced in two patients. A stroke occurred in three patients (3.9%), one of these patients subsequently died (1.3%), one recovered and one remained hemiplegic. No atrial septal defect was found after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Percutaneous transarterial mitral balloon valvuloplasty (MVP) effectively improved mitral valve area and gradient in patients with mitral stenosis. While generally safe, MVP carried a small risk of complications like stroke.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Mitral stenosis (MS) is a significant valvular heart disease requiring effective treatment.
- Percutaneous transarterial mitral balloon valvuloplasty (MVP) emerged as a less invasive alternative to surgical repair.
- Understanding the efficacy and safety of MVP in a diverse patient cohort is crucial.
Purpose of the Study:
- To evaluate the outcomes of percutaneous transarterial mitral balloon valvuloplasty (MVP) in patients with mitral stenosis.
- To assess the immediate hemodynamic and echocardiographic changes following MVP.
- To determine the safety profile and potential complications associated with the procedure.
Main Methods:
- Seventy-six patients with mitral stenosis underwent percutaneous transarterial mitral balloon valvuloplasty (MVP) between 1985 and 1987.
- Transseptal catheterization facilitated wire placement for balloon catheter advancement across the mitral valve.
- Various balloon sizes (single and double) were employed based on patient anatomy and valve characteristics.
Main Results:
- MVP resulted in significant improvements in mitral valve area (MVA) and mitral valve gradient.
- Echocardiographic measurements showed an increase in MVA and a decrease in left atrial diameter (though not statistically significant).
- Complications included no MVA enlargement in 3 patients, significant mitral regurgitation in 2, and stroke in 3 patients (1.3% mortality).
Conclusions:
- Percutaneous transarterial mitral balloon valvuloplasty (MVP) is an effective procedure for improving mitral valve function in selected patients with mitral stenosis.
- The technique demonstrated immediate hemodynamic benefits, although a small risk of serious complications, including stroke, exists.
- No significant atrial septal defects were observed post-procedure, indicating procedural safety in this aspect.