Rescue percutaneous mitral balloon valvuloplasty for iatrogenic critical mitral stenosis after open mitral valve repair for rheumatic mitral regurgitation.
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ABSTRACT:
SUBMITTER: Shah MA
PROVIDER: S-EPMC7649506 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
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Rescue percutaneous mitral balloon valvuloplasty for iatrogenic critical mitral stenosis after open mitral valve repair for rheumatic mitral regurgitation.
Shah Muhammad Azam MA Alshehri Halia Zain HZ Alsamadi Faisal F
European heart journal. Case reports 20200918 5
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Project description:BackgroundPercutaneous balloon mitral valvuloplasty (PBMV) is contraindicated in mitral stenosis (MS) with moderate mitral regurgitation (MR) according to the European guidelines. However, small-sized studies have demonstrated the feasibility and safety of PBMV in these patients. We aimed to study the procedural success and mid-term outcomes of PBMV in MS patients with moderate MR.MethodsThe present study was a retrospective cohort study in consecutive patients with severe rheumatic MS who underwent PBMV with the Inoue technique in Songklanagarind hospital. The severity of mitral regurgitation was assessed with qualitative Doppler. The patients were grouped according to their MR severity before PBMV into moderate MR or less-than-moderate MR. Procedural success and a composite of all-cause death, mitral valve surgery or re-PBMV were compared between the two groups.ResultsOf 618 patients with rheumatic MS who underwent PBMV in Songklanagarind hospital between January 2003 and October 2020, 598 patients (96.8%) had complete information of pre-PBMV MR severity and procedural success. Forty-nine patients (8.2%) had moderate MR before PBMV. Moderate MR before PBMV was not associated with a lower chance of PBMV success (moderate MR vs. less-than-moderate MR before PBMV; adjusted OR 0.65, 95% CI: 0.32-1.29, P=0.22). Survival probability of all-cause death, MV surgery or re-PBMV in the group with moderate MR before PBMV was not different from the group with less-than-moderate MR (adjusted HR 1.30, 95% CI: 0.98-1.62, P=0.10).ConclusionsPBMV is an effective and safe treatment in rheumatic MS with moderate MR.
| S-EPMC9622413 | biostudies-literature
Project description:BackgroundMany comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with "four-step" procedure in the treatment of rheumatic MS.MethodsPatients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences.ResultsA total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP. Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm2, P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively. Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent re-intervention in rMVP, but one patient died of pneumonia.ConclusionsFor selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with "four-step" procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).
| S-EPMC7711429 | biostudies-literature
Project description:BackgroundPulmonary hypertension (PH) often complicates mitral stenosis (MS). The prognostic impact of pulmonary vascular resistance (PVR) in MS patients remains unclear. Previous study has demonstrated the prognostic impact of right atrial pressure (RAP) in patients with primary PH. We aim to determine the prognostic impact of PVR and RAP in patients with rheumatic MS undergoing percutaneous mitral balloon valvuloplasty (PMBV).MethodsA total of 58 patients with symptomatic severe rheumatic MS who underwent PMBV between 2016 and 2020 were included. Patients were divided into two groups: PVR ≤ 2WU (N = 26) and PVR > 2WU (N = 32). The composite endpoint included death, reintervention or persistent NYHA functional class III-IV during follow-up.ResultsThe median age was 50 (42-60) years, with 82.8% being female. Median pulmonary artery systolic pressure (PASP) was 42 (35-50.5) mmHg. Patients with PVR ≤ 2WU had lower PASP on both echocardiogram and catheterization. The PMBV success rate was 75.9%. Multivariate analysis, adjusted for PVR, showed RAP as the only independent predictor of the composite endpoint (HR:1.507, 95% CI:1.015-2.237, p = 0.042). The optimal RAP cutoff was 9.5 mmHg (HR:3.481, 95% CI:1.041-11.641; p = 0.043).ConclusionsRAP was an independent predictor of adverse outcomes in patients with rheumatic MS undergoing PMBV, while PVR did not show prognostic significance. These findings suggest that the prognostic value of PVR may be lower than expected.
| S-EPMC11431111 | biostudies-literature
Project description:A 50 year-old male with severe rheumatic mitral stenosis was deemed too high risk for surgery and referred for percutaneous balloon valvuloplasty. The valvuloplasty was successful in reducing the trans-mitral gradient and improving the patient's symptoms, however was complicated by a tear in the posteromedial commissure and moderate mitral regurgitation.
| S-EPMC7277047 | biostudies-literature
Project description:Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied. Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function. Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated. Results: At baseline, patients had median EF of 57 (range: 45-69) %, LVEDVI of 74 (44-111) ml/m2 and LVESVI of 31 (14-57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (-16.4 vs. -13.8, p < 0.001) and global circumferential strain (GCS) (-17.8 vs. -15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (-17.9 vs. -16.4, p = 0.008) and GCS (-19.4 vs. -17.8 p = 0.03). Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.
| S-EPMC8212956 | biostudies-literature
Project description:We determined factors associated with long-term outcomes of patients who underwent successful percutaneous mitral balloon valvuloplasty (PMV).Between August 1980 and May 2013, 1187 patients underwent PMV at Severance Hospital, Seoul, Korea. A total of 742 patients who underwent regular clinic visits for more than 10 years were retrospectively analyzed. The endpoints consisted of repeated PMV, mitral valve (MV) surgery, and cardiovascular-related death.The optimal result, defined as a post-PMV mitral valve area (MVA) >1.5 cm² and mitral regurgitation ?Grade II, was obtained in 631 (85%) patients. Over a mean follow up duration of 214±50 months, 54 (7.3%) patients underwent repeat PMV, 4 (0.5%) underwent trido-PMV, and 248 (33.4%) underwent MV surgery. A total of 33 patients (4.4%) had stroke, and 35 (4.7%) patients died from cardiovascular-related reasons. In a multivariate analysis, echocardiographic score [p=0.003, hazard ratio=1.56, 95% confidence interval (CI): 1.01-2.41] and post-MVA cut-off (p<0.001, relative risk=0.39, 95% CI: 0.37-0.69) were the only significant predictors of long-term clinical outcomes after adjusting for confounding variables. A post-MVA cut-off value of 1.76 cm² showed satisfactory predictive power for poor long-term clinical outcomes.In this long-term follow up study (up to 20 years), an echocardiographic score >8 and post-MVA ?1.76 cm² were independent predictors of poor long-term clinical outcomes after PMV, including MV reintervention, stroke, and cardiovascular-related death.
| S-EPMC5823830 | biostudies-other
Project description:BackgroundRheumatic mitral valve (MV) disease is the major cause of congestive cardiac failure in children and young adults, particularly in developing countries. Mitral valve repair with minimum prosthetic material is the gold standard treatment for this condition. However, MV repair for rheumatic MV disease is known to be technically demanding.Case summaryA 27-year-old woman without a history of cardiac disease presented with dyspnoea on exertion. Echocardiography revealed rheumatic severe mitral stenosis and regurgitation, with thickening of the bileaflets, doming of the anterior leaflet, shortening of the posterior leaflet, fusions of the lateral and particularly the medial commissure, and enlargement of the mitral annulus. We successfully performed robot-assisted MV repair with bicommissural release, patch augmentation of the two leaflets, and implantation of an originally sized partial band.DiscussionRobotic MV repair can contribute to precise valve inspection and operative procedures. This approach seems feasible for complex rheumatic MV disease particularly in young patients.
| S-EPMC7047053 | biostudies-literature
Project description:BackgroundPercutaneous balloon pulmonary valvuloplasty is the procedure of choice for uncomplicated severe or symptomatic pulmonary stenosis. The present study describes our experience in balloon pulmonary valvuloplasty using the Inoue balloon catheter in adolescent and adult patients.AimsTo assess the immediate and mid-term outcomes of percutaneous balloon valvuloplasty with Inoue balloon catheter in adolescent and adult patients.Methods and resultsBetween June 2010 and July 2015, we performed percutaneous balloon pulmonary valvuloplasty with Inoue balloon catheter in 32 patients (59.37% females) aged 8 to 54 years (mean 23.6±11.5). Following the procedure, the mean right ventricular systolic pressure and the pulmonary valvular peak-to-peak systolic gradient decreased from (121.6±42.4 to 61.19±24.5mmHg, p=0.001) and (100.9±43.3 to 36.4±22.5mmHg, p=0.001), respectively. Twenty patients (Group A) showed immediate optimal results with post-procedure peak systolic gradient <36mmHg while 12 patients (Group B) had suboptimal results. An increase in pulmonary regurgitation by one grade was detected in 17 patients (53.2%). Twenty-three patients available for follow-up (mean duration, 2.75 years [range 0.25-5 years]) had a mean residual peak gradient of 23.6±2.51mmHg on Doppler echocardiography with attenuation of reactive RVOT stenosis in all Group B patients. There was no further increase in grade of pulmonary regurgitation or restenosis on mid-term follow-up.ConclusionPercutaneous Inoue balloon technique is an attractive alternative with excellent mid-term results for adolescents and adults with isolated pulmonary stenosis.
| S-EPMC5415049 | biostudies-literature
Project description: Not available
| S-EPMC9725015 | biostudies-literature
Project description:We present the case of a 58-year-old man who had complex reoperative bioprosthetic mitral valve replacement under femorofemoral venoarterial extracorporeal life support. The patient experienced early bioprosthetic valve failure due to leaflet fusion. This complication could be treated successfully using isolated percutaneous balloon valvuloplasty that allowed restoration of full leaflet mobility.
| S-EPMC6426074 | biostudies-literature