Page 11 - Journal of Structural Heart Disease Volume 3, Issue 2

37 Original Scienti c Article
Figure 1. Comparison between those with and without MR as regard W.S. Calci cation
≥1.5 cm2 and there was no more than one grade increase in mitral regurgitation or no increase in gain above 50% of base- line without major complications. Major complications were de ned as more than grade 2/4 mitral regurgitation, cerebro- vascular stroke, cardiac tamponade, thromboembolic events, or balloon rupture with unwanted sequelae or periprocedural death.
Statistical Analysis
Data were analyzed using STATA/IC version 12.1. Quan- titative data are reported as mean and standard deviation. Normally distributed or not normally distributed data were analyzed using Student’s t-tests or Mann-Whitney tests, re- spectively. Qualitative data are reported as frequency and per- centage and were analyzed using Chi-square tests or Fisher’s exact tests. Statistical signi cance was set at p < 0.05.
Results
Pre-Operative Characteristics
The female-to-male ratio of included patients was 4:1 (Table 1). The predominant symptom before the procedure was heart failure, which was observed in 95% of patients. Symptoms of heart failure were severe (class III or IV) in 65% of patients. A history of cerebrovascular stroke was present in one patient (2.5%). Approximately 60% of patients were cate- gorized as NYHA functional class III, 35% as class II, 4% as class I, and 1% as class IV.
Intraoperative Events and Procedure-Related Complications
Most patients (75%) exhibited sinus rhythm during the procedure, whereas some patients (25%) exhibited atrial bril- lation. Technical failure occurred in two patients due to failure of the balloon to traverse tight valves.
Non-signi cant increases in mitral regurgitation occurred in three patients, and one patient experienced severe mi- tral regurgitation that required surgical valve replacement (Table 4). Minor complications included vasovagal reaction in two patients, prolonged hypotension in one patient, and arrhythmia (i.e., multifocal ventricular ectopic beats) requiring treatment in one patient. Bleeding from the right femoral vein associated with balloon catheter insertion occurred in two pa- tients (5%), with neither patient requiring blood transfusion. There was no in-hospital mortality (0%).
Mean mitral regurgitation grade increased signi cantly from 0.91 ± 0.54 before PBMV to 1.11 ± 0.56 post-dilatation (p < 0.01). Before valvuloplasty, 26 patients had no mitral re- gurgitation, 12 patients had grade 1, two patients had grade 2, and no patients had grade 3 or 4 mitral regurgitation as evaluated by Doppler studies. After valvuloplasty, mitral regurgitation remained unchanged in most patients. Howev- er, the degree of mitral regurgitation increased by one grade in four patients (10%): three increased from grade 1 to grade 2, and one increased from grade 2 to grade 3.
When we investigated factors associated with the develop- ment of signi cant mitral regurgitation (i.e., grade 2 or higher), we found a signi cant increase in the incidence of signi cant mitral regurgitation among female patients, patients with atri- al brillation rather than sinus rhythm, and patients who un-
Mahmoud, S.E.S. et al.
Percutaneous Balloon Mitral Valvuloplasty