Page 12 - Journal of Structural Heart Disease Volume 3, Issue 2

Original Scienti c Article
38
Table 3. General outcomes of studied population.
Outcome
Success 75% Failure 25%
New Mitral regurgitation or increased grade 10%
Table 5. Factor a ecting occurrence of signi cant Mitral regur- gitation (SMR).
Statistical analysis
Features
Signi cant (≥+2) increase or new SMR
P value
No
Yes
Patients with Signi cant increase “ ≥2+”Mitral regurgitation
2.5%
Gender
Females Males
Height
L A diameter
Rhythm
Sinus
Atrial brillation (AF)
Previous BMV/ surgery
No Yes
W.S. Thickness
1 2 3
W.S. Mobility
1 2 3
W.S. Subvalvular
1 2 3 4
W.S. Calci cation
1 2 3 4
Pre-operative MVA Pre-operative PG Pre-operative PASP
(80.69%) (91.31%)
162.28±8.13 5.01±0.49
(77.9%) (22.1%)
(88.97%) (11.03%)
(21.38%) (55.17%) (23.45%)
(27.59%) (64.14%) (8.28%)
(18.6%) (69%) (11.7%) (0.06%)
(22.7%) (56.5%) (19.3%) (1.5%)
0.96±0.18 26.34±5.34 52.95±14.06
(55.56%) 0.03 (44.44%)
165.14±7.01 0.16 5.12±0.84 0.41
(27.7%) <0.0001 (72.3%)
(66.67%) 0.02 (33.33%)
(16.67%) 0.64 (50.00%)
(33.33%)
(16.67%) 0.37 (66.67%)
(16.67%)
Table 4. Technical failures and Complications related to percuta- neous balloon mitral valvuloplasty.
Complication
(n)
%
Technical failure
Vasovagal reaction
Prolonged hypotension Arrhythmias requiring treatment Balloon rupture, no sequaele Bleeding from RT femoral vein Signi cant hematoma
Mitral regurgitation Severe mitral regurgitation Atrial septal defect Cardiac tamponade Thromboembolism
Death
2 5% 2 5% 1 2.5% 1 2.5% 0 0% 2 5% 1 2.5% 4 10% 1 2.5% 0 0% 0 0% 0 0% 0 0%
(22.2%) (16.7%) (55.5%) (5.6%)
<0.0001
derwent redo PBMV or had previous surgical commissurotomy (Table 5). Signi cant mitral regurgitation was non-signi cantly associated with a higher Wilkin’s score. However, upon further analysis of Wilkin’s score parameters, we found that calci ca- tion, especially commissural calci cation, and higher subval- vular involvement were signi cantly associated with signi - cant mitral regurgitation (p < 0.0001; Table 5 and Figure 1).
Post-Operative Outcomes
We de ned signi cant symptomatic improvement as an improvement by one or more NYHA functional classi cations achieved by 1-month follow-up. We observed a signi cant change in NYHA functional classi cation from 2.56 ± 0.58 pre-PBMV to 1.09 ± 0.29 post-PBMV (p < 0.0001). One patient changed from class IV to ΙΙ, 10 patients changed from class ΙΙΙ to Ι, 10 patients changed from class ΙΙ to Ι, and 15 patients changed from class ΙΙΙ to ΙΙ.
(11.1%) <0.0001 (22.3%)
(33.3%)
(33.3%)
0.90±0.13 0.17 25.00±4.32 0.31 51.00±11.07 0.57
L A= Left Atrial; W.S. = Wilkins score; BMV = balloon mitral valvotomy; MVA = mitral valve areas; PG = prostaglandin; PASP = pulmonary artery systolic pressure.
Of the 10 patients with chronic atrial brillation, one re- verted spontaneously to regular sinus rhythm after successful PBMV.
The primary end-point of procedural success commonly accepted by investigators is a nal valve area >1.5 cm2 without moderate or severe mitral regurgitation. We found that mitral valve area as assessed by planimetry increased signi cantly in all patients after valvuloplasty. The mean valve area was 0.96
Journal of Structural Heart Disease, April 2017
Volume 3, Issue 2:35-42