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Percutaneous Inoue-balloon valvuloplasty in patients with mitral stenosis and associated moderate mitral
Insights
Percutaneous Inoue-balloon mitral valvuloplasty is safe and effective for mitral stenosis, even with moderate mitral regurgitation. This procedure offers sustained symptom relief with a low risk of severe complications.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Mitral stenosis is a significant valvular heart disease requiring effective treatment.
- Percutaneous mitral valvuloplasty is an alternative to surgical intervention.
- The impact of preexisting moderate mitral regurgitation on valvuloplasty outcomes is not fully elucidated.
Purpose of the Study:
- To compare the outcomes of percutaneous Inoue-balloon mitral valvuloplasty in patients with and without moderate mitral regurgitation.
- To evaluate the safety and efficacy of a height-derived balloon-sizing method in mitral valvuloplasty.
- To assess the risk of developing severe mitral regurgitation post-procedure.
Main Methods:
- Retrospective comparison of 21 patients with moderate mitral regurgitation (group A) and 83 patients without (group B).
- All procedures utilized the Inoue-balloon technique with a height-derived balloon-sizing method.
- Echocardiographic and angiographic assessments were performed to evaluate mitral valve area, regurgitation, and procedural success.
Main Results:
- Successful valvuloplasty was achieved in all patients without complications.
- Group B showed significantly higher immediate increases in mitral valve area (0.9 cm² vs. 0.7 cm²) and optimal valvuloplasty results (99% vs. 90%) compared to group A.
- A mild increase in mitral regurgitation was more common in group B (22% vs. 0%), with no patient developing severe regurgitation (grade ≥ 3/4).
Conclusions:
- Percutaneous Inoue-balloon mitral valvuloplasty using the height-derived balloon-sizing method is safe and effective in selected patients with mitral stenosis, including those with moderate mitral regurgitation.
- The procedure leads to effective mitral valve enlargement and sustained midterm symptomatic benefits.
- The risk of developing severe mitral regurgitation is low, even in the presence of concomitant moderate mitral regurgitation.
Abstract:
The present study compares the outcome of percutaneous Inoue-balloon mitral valvuloplasty performed in 21 patients with (group A) and 83 patients without (group B) preexisting moderate mitral regurgitation, using our height-derived balloon-sizing method. All procedures were successfully completed without untoward complications. The immediate increments in mitral valve area measured by echocardiographic methods and optimal valvuloplasty results were significantly higher in group B compared with group A (0.9 cm2 vs. 0.7 cm2, P = 0.01, and 99% vs. 90%, P = 0.007, respectively). No patients in either group sustained a final grade > or = 3/4 angiographic mitral regurgitation. A mild increase in mitral regurgitation was encountered more commonly in group B than in group A patients (22% vs. 0%, P = 0.03). At a mean follow-up of 19-20 months, the substantial majority of patients (> or = 90%) in both groups continued to experience maintained symptomatic benefits. In conclusion, our preliminary data seem to indicate that percutaneous Inoue-balloon mitral valvuloplasty using our height-derived balloon-sizing method in the stepwise dilatation approach in selected patients with significant mitral stenosis and concomitant moderate mitral regurgitation is associated with a low risk of developing severe mitral regurgitation, with effective mitral valve enlargement, and with sustained midterm symptomatic benefits.