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Manjunath C, Khan AA, Dangas GD, Kaul U. Balloon Mitral Valvuloplasty. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Dadjo Y, Moshkani Farahani M, Nowshad R, Sadeghi Ghahrodi M, Moaref A, Kojuri J. Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis. BMC Cardiovasc Disord 2021; 21:355. [PMID: 34320949 PMCID: PMC8317406 DOI: 10.1186/s12872-021-02175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 07/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. Methods In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. Results During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). Conclusion The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108). Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02175-3.
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Affiliation(s)
- Yahya Dadjo
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Reza Nowshad
- Cardiology Department, Clinical Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Zand St., Cardiology Office, Shiraz, Iran.,Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Alireza Moaref
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Cardiology Department, Clinical Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Zand St., Cardiology Office, Shiraz, Iran.
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Manjunath C, Moorthy N, Kaul U. Balloon Mitral Valvuloplasty. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- C.N. Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore India
| | - Nagaraja Moorthy
- Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore India
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Miura S, Arita T, Domei T, Yamaji K, Soga Y, Hyodo M, Shirai S, Ando K. Impact of preprocedural atrial fibrillation on immediate and long-term outcomes after successful percutaneous mitral valvuloplasty of significant mitral stenosis. Cardiovasc Interv Ther 2016; 33:46-54. [PMID: 27709537 PMCID: PMC5754370 DOI: 10.1007/s12928-016-0434-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
Optimal time to perform percutaneous mitral valvuloplasty (PMV) for patients with significant mitral stenosis (MS) and atrial fibrillation (AF) remains controversial. We sought to identify prognostic factors and evaluate long-term clinical outcomes after PMV of 77 consecutive patients with MS with a mitral valve area (MVA) <1.5 cm2. According to baseline heart rhythm, these patients were divided into sinus rhythm (SR; n = 24) and AF (n = 53) groups. The study endpoint was defined as a composite of all-cause mortality, admission for heart failure, mitral valve surgery, repeated PMV, and major cerebral vascular accident during follow-up. After successful PMV, there was no significant difference between the two groups in post-MVA and post-mitral mean pressure gradient. However, the New York Heart Association Functional Classification post-procedure was worse in the AF group (p < 0.01). In the AF group, event-free survival during follow-up was significantly lower compared with that of the SR group (p = 0.016). Independent predictors of clinical events were AF [hazard ratio (HR), 2.73; 95 % confidence interval (CI), 1.04-9.36; p = 0.03] and pulmonary artery systolic pressure (HR 2.57; 95 % CI 1.18-5.47; p = 0.017). Patients with AF at baseline were significantly associated with worse symptoms and higher event rates after successful PMV compared with those with SR. The clinical benefit of PMV may be considered for patients with MVA <1.5 cm2 before the onset of AF.
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Affiliation(s)
- Shiro Miura
- Department of Social, Human and Mathematical Sciences, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK.
| | - Takeshi Arita
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Makoto Hyodo
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Russell EA, Tran L, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Walsh WF, Maguire GP. A review of valve surgery for rheumatic heart disease in Australia. BMC Cardiovasc Disord 2014; 14:134. [PMID: 25274483 PMCID: PMC4196004 DOI: 10.1186/1471-2261-14-134] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects older non-Indigenous Australians and Aboriginal Australians and/or Torres Strait Islander peoples. Factors associated with the choice of treatment for advanced RHD remain variable and poorly understood. METHODS The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. Demographics, co-morbidities, pre-operative status and valve(s) affected were collated and associations with management assessed. RESULTS Surgical management of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients were younger, more likely to be female and Indigenous Australian, to have atrial fibrillation (AF) and previous percutaneous balloon valvuloplasty (PBV). Surgery was performed on one valve in 64.5%, two valves in 30.0% and three valves in 5.5%. Factors associated with receipt of mechanical valves in RHD were AF (OR 2.69) and previous PBV (OR 1.98) and valve surgery (OR 3.12). Predictors of valve repair included being Indigenous (OR 3.84) and having fewer valves requiring surgery (OR 0.10). Overall there was a significant increase in the use of mitral bioprosthetic valves over time. CONCLUSIONS RHD valve surgery is more common in young, female and Indigenous patients. The use of bioprosthetic valves in RHD is increasing. Given many patients are female and younger, the choice of valve surgery and need for anticoagulation has implications for future management of RHD and related morbidity, pregnancy and lifestyle plans.
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Affiliation(s)
- Elizabeth Anne Russell
- />Baker IDI Central Australia, PO Box 1294, Alice Springs, NT 0811 Australia
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Lavinia Tran
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Robert A Baker
- />Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA Australia
| | - Jayme S Bennetts
- />Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA Australia
- />Department of Surgery, School of Medicine, Flinders University, Adelaide, SA Australia
| | - Alex Brown
- />Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, SA Australia
- />School of Population Health, University of South Australia, Adelaide, SA Australia
| | - Christopher Michael Reid
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Robert Tam
- />Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | | | - Graeme Paul Maguire
- />Baker IDI Central Australia, PO Box 1294, Alice Springs, NT 0811 Australia
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
- />School of Medicine, James Cook University, Cairns, Queensland Australia
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Mitral balloon valvotomy, long-term results, its impact on severe pulmonary hypertension, severe tricuspid regurgitation, atrial fibrillation, left atrial size, left ventricular function. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chmielak Z, Klopotowski M, Kruk M, Demkow M, Konka M, Chojnowska L, Hoffman P, Witkowski A, Ruzyllo W. Repeat percutaneous mitral balloon valvuloplasty for patients with mitral valve restenosis. Catheter Cardiovasc Interv 2010; 76:986-92. [DOI: 10.1002/ccd.22608] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gupta S, Gupta N, Arand P, Michaels AD. Computerized acoustic cardiography correlates with echocardiography and invasive haemodynamics after percutaneous transvenous mitral commissurotomy. J Med Eng Technol 2010; 35:59-64. [PMID: 21039322 DOI: 10.3109/03091902.2010.525687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Rheumatic mitral stenosis severity has been assessed by the systolic time interval between the QRS onset and the first heart sound (QS1) by phonocardiography. We hypothesized that non-invasive computerized acoustic cardiography could evaluate mitral stenosis severity compared with echocardiography and invasive haemodynamics in patients undergoing percutaneous transvenous mitral commissurotomy (PTMC). METHODS 27 patients underwent computerized acoustic cardiography, echocardiography, and invasive haemodynamic measurements prior to and after PTMC. RESULTS The mean age was 31 ± 10 years, and 21 (78%) were female. By echocardiography, mitral valve area increased from 0.82 ± 0.14 to 1.50 ± 0.24 cm(2) (p < 0.0001). The QS1 interval decreased from 101.7 ± 12.9 to 93.2 ± 9.2 ms (p < 0.0001). The change in the QS1 interval correlated with the change in mitral valve area by echocardiography (p = 0.037), right ventricular systolic pressure (p < 0.0001), and the invasive mitral valve gradient (p = 0.076). CONCLUSIONS Acoustic cardiography may be used as an adjunctive non-invasive diagnostic tool to assess mitral stenosis severity.
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Affiliation(s)
- S Gupta
- Department of Medicine, Division of Cardiology, Oregon Health & Science University, UHN-62, 3181 SW Sam Jackson Park Road, Portland, Oregon, USA
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Fawzy ME. Mitral balloon valvuloplasty. J Saudi Heart Assoc 2010; 22:125-32. [PMID: 23960605 PMCID: PMC3727492 DOI: 10.1016/j.jsha.2010.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 04/28/2010] [Indexed: 11/17/2022] Open
Abstract
Percutaneous mitral balloon valvuloplasty (MBV) was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, MBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis (MS). With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. When the reported complications of MBV are viewed in aggregate, complications occur at approximately the following rates: mortality (0-0.5%), cerebral accident (1-2%), mitral regurgitation (MR) requiring surgery (1.6-3%). These complication rates compare favorably to those reported after surgical commissurotomy. Several randomized trials reported similar hemodynamic results with MBV and surgical commissurotomy. Restenosis after MBV ranges from 4% to 70% depending on the patient selection, valve morphology, and duration of follow-up. Restenosis was encountered in 31% of the author's series at mean follow-up 9 ± 5.2 years (range 1.5-19 years) and the 10, 15, and 19 years restenosis-free survival rates were (78 ± 2%) (52 ± 3%) and (26 ± 4%), respectively, and were significantly higher for patients with favorable mitral morphology (MES ⩽ 8) at 88 ± 2%, 67 ± 4% and 40 ± 6%), respectively (P < 0.0001). The 10, 15, and 19 years event-free survival rates were (88 ± 2%, 60 ± 4% and 28 ± 7%, respectively, and were significantly higher for patients with favorable mitral morphology (92 ± 2%, 70 ± 4% and 42 ± 7%, respectively (P < 0.0001). The effect of MBV on severe pulmonary hypertension, concomitant severe tricuspid regurgitation, left ventricular function, left atrial size, and atrial fibrillation are addressed in this review. In addition, the application of MBV in specific clinical situations such as in children, during pregnancy and for restenosis is discussed.
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Nobuyoshi M, Arita T, Shirai SI, Hamasaki N, Yokoi H, Iwabuchi M, Yasumoto H, Nosaka H. Percutaneous balloon mitral valvuloplasty: a review. Circulation 2008; 119:e211-9. [PMID: 19106383 DOI: 10.1161/circulationaha.108.792952] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Masakiyo Nobuyoshi
- Department of Cardiology, Kokura Memorial Hospital, Kokura-kitaku, Kitakyushu, Japan.
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