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Dayawansa NH, Baratchi S, Peter K. Uncoupling the Vicious Cycle of Mechanical Stress and Inflammation in Calcific Aortic Valve Disease. Front Cardiovasc Med 2022; 9:783543. [PMID: 35355968 PMCID: PMC8959593 DOI: 10.3389/fcvm.2022.783543] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is a common acquired valvulopathy, which carries a high burden of mortality. Chronic inflammation has been postulated as the predominant pathophysiological process underlying CAVD. So far, no effective medical therapies exist to halt the progression of CAVD. This review aims to outline the known pathways of inflammation and calcification in CAVD, focussing on the critical roles of mechanical stress and mechanosensing in the perpetuation of valvular inflammation. Following initiation of valvular inflammation, dysregulation of proinflammatory and osteoregulatory signalling pathways stimulates endothelial-mesenchymal transition of valvular endothelial cells (VECs) and differentiation of valvular interstitial cells (VICs) into active myofibroblastic and osteoblastic phenotypes, which in turn mediate valvular extracellular matrix remodelling and calcification. Mechanosensitive signalling pathways convert mechanical forces experienced by valve leaflets and circulating cells into biochemical signals and may provide the positive feedback loop that promotes acceleration of disease progression in the advanced stages of CAVD. Mechanosensing is implicated in multiple aspects of CAVD pathophysiology. The mechanosensitive RhoA/ROCK and YAP/TAZ systems are implicated in aortic valve leaflet mineralisation in response to increased substrate stiffness. Exposure of aortic valve leaflets, endothelial cells and platelets to high shear stress results in increased expression of mediators of VIC differentiation. Upregulation of the Piezo1 mechanoreceptor has been demonstrated to promote inflammation in CAVD, which normalises following transcatheter valve replacement. Genetic variants and inhibition of Notch signalling accentuate VIC responses to altered mechanical stresses. The study of mechanosensing pathways has revealed promising insights into the mechanisms that perpetuate inflammation and calcification in CAVD. Mechanotransduction of altered mechanical stresses may provide the sought-after coupling link that drives a vicious cycle of chronic inflammation in CAVD. Mechanosensing pathways may yield promising targets for therapeutic interventions and prognostic biomarkers with the potential to improve the management of CAVD.
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Affiliation(s)
- Nalin H. Dayawansa
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Sara Baratchi
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karlheinz Peter
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Karlheinz Peter,
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Al-Hijji M, Ahmed A, Mohammed N, Rahhal A, Alzaeem H, Maaly C, Mousa T, Al Asmi S, Bitar B, Al-Kindi F, Arafa S, Al-Qahtani A. Percutaneous transvenous balloon mitral commissurotomy: A single-center experience. Heart Views 2022; 23:127-132. [DOI: 10.4103/heartviews.heartviews_78_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022] Open
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3
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Mutagaywa RK, Wind AM, Kamuhabwa A, Cramer MJ, Chillo P, Chamuleau S. Rheumatic heart disease anno 2020: Impacts of gender and migration on epidemiology and management. Eur J Clin Invest 2020; 50:e13374. [PMID: 32789848 PMCID: PMC7757241 DOI: 10.1111/eci.13374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The epidemiology and management of diseases can be influenced by social demographic factors. Gender and migration are among these factors. METHODS We aimed at reviewing the impacts of gender and migration on rheumatic heart disease (RHD) epidemiology and management by a nonsystematic literature review of published studies on RHD worldwide. Our PubMed search terms included RHD pathophysiology, diagnosis, complications, management or prevention, combined with words 'rheumatic mitral stenosis (MS)', 'outcomes after percutaneous balloon mitral valvuloplasty (PBMV)', 'gender or sex difference' and 'migration'. The reporting of this study conforms to SANRA (the Scale for Assessment of Narrative Review Articles) guidelines. RESULTS We retrieved eight studies about the impact of sex on outcomes after PBMV. All of these studies showed a female predominance for RHD. Two studies showed that there is no impact, three studies showed female sex as a predictor of poor outcomes, and the other three showed male sex a predictor of poor outcomes. Although RHD is reported to be eradicated in the developed countries, 2.1% of refugees recently screened for RHD in Italy were found to have subclinical RHD. This prevalence is similar to those found in India (2.0%), Cambodia (2.2%) and Mozambique (3%). CONCLUSIONS There are contradicting results for outcomes after PBMV between males and females. It is not clear whether sex difference plays a role in pathophysiology, diagnosis, management and prognosis of MS. Migration has impacts on epidemiology and management of RHD. Further studies are required in these two fields to explore their relationship to RHD.
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Affiliation(s)
- Reuben K Mutagaywa
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.,Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anna-Maria Wind
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Apolinary Kamuhabwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Maarten J Cramer
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pilly Chillo
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Steven Chamuleau
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.,Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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4
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Venkateshvaran A, Govind SC. Left ventricular diastolic function in mitral stenosis. Echocardiography 2020; 37:1944-1950. [PMID: 32562447 DOI: 10.1111/echo.14773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
The assessment of left ventricular (LV) function in the setting of mitral stenosis (MS) has been critically examined for decades. Accurate assessment of aberrations in diastolic function is important as these subjects often present with signs and symptoms of heart failure and pulmonary congestion that cannot be solely explained by the severity of mechanical obstruction. Echocardiographic evaluation of diastolic dysfunction includes an evaluation of reduced LV compliance, diminished restoring forces, and enhanced stiffness, which are challenging in the setting of MS owing to altered hemodynamic loading. Conventional echocardiographic and Doppler measures offer limited information. Novel assessments employing speckle tracking echocardiography are relatively less studied. A more comprehensive assessment including clinical evaluation, identification of concomitant disorders, and comorbidities is particularly warranted in older subjects with degenerative MS to suspect diastolic dysfunction and arrive at optimal medical therapy or intervention. This review provides an overview of etiological, pathophysiological, echocardiographic, and invasive assessment of diastolic dysfunction in the setting of MS, with specific focus on strengths and limitations of available echocardiographic and Doppler techniques.
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Affiliation(s)
- Ashwin Venkateshvaran
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Satish C Govind
- Department of Non-Invasive Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
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5
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Lekhakul A, Fenstad ER, Assawakawintip C, Pislaru SV, Ayalew AM, Maalouf JF, Nkomo VT, Thaden J, Oh JK, Sinak LJ, Kane GC. Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology. Mayo Clin Proc 2018; 93:1086-1095. [PMID: 30077202 DOI: 10.1016/j.mayocp.2018.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE As invasive cardiovascular care has become increasingly complex, cardiac perforation leading to hemopericardium is a progressively prevalent complication. We sought to assess the frequency, etiology, and outcomes of hemorrhagic pericardial effusions managed through a nonsurgical echo-guided percutaneous strategy. PATIENTS AND METHODS Over a 10-year period (January 1, 2007, to December 31, 2016), 1097 unique patients required pericardiocentesis for clinically important pericardial effusions. Of these 411 had drainage of hemorrhagic effusions (defined as a pericardial hemoglobin level >50% of serum hemoglobin or frank blood in the setting of cardiac perforation). Clinical characteristics, echocardiographic data, details of the procedure, and outcomes were determined. RESULTS Median patient age was 67 years (interquartile range, 56-76 years), and 60% were men. The procedure was emergent in 83% and elective in 17%. The site of pericardiocentesis was determined by echo-guidance in all: 68% from the left para-apical region, 18% from the left or right parasternal areas, and 14% were subxyphoid. Half (n=215 [52%]) occurred after cardiac perforation with percutaneous interventional procedure (ablation, n=94; device lead implantation, n=65; percutaneous coronary intervention, n=22; other, n=34), whereas 30% followed cardiac or thoracic surgery. Pericardial fluid volume drained was 546±440 mL. In 94% of cases, echo-guided pericardiocentesis was the only treatment of the effusion needed, whereas definitive surgery was required in 25 (6%) cases for persistent bleeding or acute management of the underlying etiology. There was no procedural mortality. Late mortality was better for hemorrhagic effusions compared with a contemporary cohort with nonhemorrhagic effusions. CONCLUSION Echocardiographic guidance allows rapid successful pericardiocentesis in the setting of hemopericardium related to microperforation with interventional procedures, malignancy, or pericarditis, with most not requiring surgical intervention. Surgery should remain the first-line approach for aortic dissection or myocardial rupture.
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Affiliation(s)
- Annop Lekhakul
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Eric R Fenstad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Assefa M Ayalew
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Joseph F Maalouf
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jeremy Thaden
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Larry J Sinak
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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6
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Kale SB, Jagannathan R. Delayed complication of balloon mitral commisurrotomy. a rare case scenario. Indian J Thorac Cardiovasc Surg 2018; 34:417-419. [PMID: 33060906 DOI: 10.1007/s12055-017-0612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022] Open
Abstract
The last two decades has seen percutaneous transmitral commissurotomy turn out to be the standard of care in most patients with symptomatic mitral stenosis with a large body of evidence reporting excellent outcome on the short- and long-term with low incidence of serious complications. Complications necessitating urgent surgery are rare and include acute severe mitral regurgitation from mitral valve tear and cardiac tamponade due to cardiac chamber perforation. We report a rare extracardiac bleeding complication of balloon valvotomy presenting a month after the procedure with severe symptoms and mediastinal shift warranting emergency redo sternotomy and mediastinal thrombectomy.
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Affiliation(s)
- Suresh Babu Kale
- Institute for Cardiac Treatment and Research, Southern Railway Headquarters Hospital, Perambur, Chennai, 600023 India.,Meenakshi Hospital, Trichy Road, Tanjore, Tamil Nadu 613005 India
| | - Raghavan Jagannathan
- Institute for Cardiac Treatment and Research, Southern Railway Headquarters Hospital, Perambur, Chennai, 600023 India
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7
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Binney N. The function of the heart is historically contingent. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2018; 68-69:42-55. [PMID: 29779797 DOI: 10.1016/j.shpsc.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 05/05/2018] [Accepted: 05/06/2018] [Indexed: 06/08/2023]
Abstract
Some philosophers of medicine argue that there are objective facts about the biological function of organs, and that these facts are used to objectively define diseases. The function of the heart is taken to be particularly obvious and well established. Contrary to this, I argue that the function of the heart is not fixed by nature, but rather that it is historically contingent. The disease heart failure results from the dysfunction of the heart. In opposition to the common-sense intuitions of philosophers, medics do not define heart failure simply as a reduced cardiac output, and up to half of patients with heart failure have a normal cardiac output. The present day medical definition of heart failure is thus counter-intuitive. In the early twentieth century, however, medics did define heart failure as a reduced cardiac output. This view was opposed in the 1930s, when a similar definition of heart failure to the one used today was put forward. I look closely at this historical episode, in order to explore the reasons for this development. I use this history to argue that present day knowledge of heart failure is not the inevitable result of careful observation of patients, but rather is historically contingent.
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Affiliation(s)
- Nicholas Binney
- EGENIS - The Centre for the Study of the Life Sciences, Byrne House, St. German's Road, Exeter, Devon, EX4 4PJ, UK.
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8
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Kim D, Chung H, Nam JH, Park DH, Shim CY, Kim JS, Chang HJ, Hong GR, Ha JW. Predictors of Long-Term Outcomes of Percutaneous Mitral Valvuloplasty in Patients with Rheumatic Mitral Stenosis. Yonsei Med J 2018; 59:273-278. [PMID: 29436196 PMCID: PMC5823830 DOI: 10.3349/ymj.2018.59.2.273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We determined factors associated with long-term outcomes of patients who underwent successful percutaneous mitral balloon valvuloplasty (PMV). MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Darae Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyemoon Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ho Nam
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jong Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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9
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Khan I, Shah B, Habeel Dar M, Khan A, Faisal Iftekhar M, Sami A. Clinical and Echocardiographic Follow-up after Successful Percutaneous Transvenous Mitral Commissurotomy. Cureus 2017; 9:e1726. [PMID: 29201575 PMCID: PMC5707169 DOI: 10.7759/cureus.1726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The objective of the study was to determine the long-term outcomes, including mitral restenosis and regurgitation, after successful percutaneous transvenous mitral commissurotomy (PTMC). Methods This cross-sectional prospective study was conducted at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from January 2007 to December 2009. A total of 84 patients were followed up for a period of 96 months. Pre and post percutaneous transvenous mitral commissurotomy echocardiography was done on the mitral valve area (MVA) using two-dimensional (2D) and color doppler echocardiography. Patients who had successful PTMC were followed up for MVA loss, mitral regurgitation (MR), and cardiac death. SPSS Software (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.; 2013) was used for data analysis. Results Of the 84 patients, 21 were male, and 63 were females. The mean age was 35 ± 11 years. After PTMC, the mean valve two-dimensional area increased from 0.84 ± 0.13 to 1.83 ± 0.49 cm2 (p value <0.001). MR was mild in 49 patients (62.8%), moderate in 27 patients (34.6%), and severe in two patients (2.6%). Good results were achieved in 60 (71.4%). Patients with good results were younger (24 ± 4), and had a relatively lower Wilkin's score, with a mean value of (8.4 ± 2.8). Follow-up events were death in six patients, mitral valve replacement (MVR) in 10 patients, and restenosis in seven patients. The Kaplan-Meier curve was used for the follow-up end points. Patient who required PTMC for mitral restenosis survived for a longer time than those requiring MVR, and those who had cardiac death due to severe pulmonary hypertension or heart failure. Conclusion Patients who had favorable Wilkin’s score and underwent PTMC for severe symptomatic mitral stenosis had better event-free survival in the long term follow-up.
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Affiliation(s)
- Imran Khan
- Cardiology/cardiac Electrophysiology, Hayatabad Medical Complex Peshawar
| | | | | | - Adnan Khan
- House Officer, Rehman Medical Institute, Peshawar
| | | | - Abdul Sami
- Cardiology, Hayatabad Medical Complex Peshawar
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10
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Nunes MCP, Tan TC, Elmariah S, Lodi-Junqueira L, Nascimento BR, do Lago R, Padilha da Silva JL, Reis RCP, Zeng X, Palacios IF, Hung J, Levine RA. Net atrioventricular compliance is an independent predictor of cardiovascular death in mitral stenosis. Heart 2017; 103:1891-1898. [PMID: 28780580 DOI: 10.1136/heartjnl-2016-310955] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Rheumatic mitral stenosis (MS) is a progressive disease, and risk of death may persist despite relief of the obstruction. Net atrioventricular compliance (Cn) modulates the overall haemodynamic burden of the MS and may be useful in predicting cardiovascular death after percutaneous mitral valvuloplasty (PMV). METHODS A total of 427 patients (mean age 50±16 years, 84% female) with severe MS undergoing PMV were enrolled. Doppler-derived Cn was estimated at baseline using a previously validated equation. The primary endpoint was late cardiovascular death, and the secondary endpoint was a composite of all-cause mortality, mitral valve (MV) replacement or repeat PMV over a median follow-up of 31 months (IQR: 7.8-49.2 months). RESULTS At baseline, 209 patients (49%) were in New York Heart Association (NYHA) functional class III or IV. During follow-up, 49 patients died (41 cardiovascular deaths), 50 underwent MV replacement and 12 required repeat PMV, with an overall incidence of cardiac mortality and adverse events of 4.1 deaths and 11.1 events per 100 patient-years, respectively. Low baseline Cn was a strong predictor of both cardiac death (adjusted HR 0.70, 95% CI 0.49 to 0.86) and composite endpoint (adjusted HR 0.81, 95% CI 0.67 to 0.91) after adjusting for clinical factors, baseline pulmonary artery pressure, tricuspid regurgitation severity, right ventricular function and immediate procedural haemodynamic data. The inclusion of Cn in a model with conventional parameters resulted in improvement in 5-year cardiovascular mortality risk prediction. CONCLUSIONS Baseline Cn is a strong predictor of cardiovascular death in patients with MS undergoing PMV, independent of other prognostic markers of decreased survival in MS, including baseline patient characteristics and postprocedural data. Cn assessment therefore has potential value in evaluation of cardiovascular mortality risk in the setting of MS.
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Affiliation(s)
- Maria Carmo Pereira Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy C Tan
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sammy Elmariah
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucas Lodi-Junqueira
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo do Lago
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Xin Zeng
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Igor F Palacios
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Judy Hung
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert A Levine
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Kiefer P, Noack T, Seeburger J, Hoyer A, Linke A, Mangner N, Lehmkuhl L, Mohr FW, Holzhey D. Transapical Mitral Valve Implantation for Native Mitral Valve Stenosis Using a Balloon-Expandable Prosthesis. Ann Thorac Surg 2017; 104:2030-2036. [PMID: 28760473 DOI: 10.1016/j.athoracsur.2017.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transcatheter mitral valve implantation (TMVI) is still in its infancy and is mainly limited to valve-in-valve or valve-in-ring implantations. We present the early experience with TMVI for severe calcified native MV stenosis. METHODS Between January 2014 and June 2015, 6 of 11 patients screened (mean age, 77.4 ± 6.3 years; 66% men) with severe native mitral valve (MV) stenosis (mean gradient [Pmean], 11.1 ± 2.1 mm Hg; mean effective orifice area [EOA], 0.9 ± 0.12 cm2) underwent transcatheter MV replacement at our institution as a bailout procedure. Conventional surgical procedures were denied in all patients because of severe annular calcification and extensive comorbidities (mean logistic EuroScore, 31.4% ± 8.3%). The Edwards SAPIEN 3 (29 mm) (Edwards Lifesciences, Irvine, CA) was used in all cases. Procedural access was transapical in 5 cases and concomitant to aortic valve replacement through the left atrium through a sternotomy in 1 case. RESULTS Initial implantation was successful in 100% of the cases. Because of early migration, 1 patient needed a valve-in-valve procedure. Postoperative echocardiography showed no residual mitral regurgitation in 4 cases (66%) and mild regurgitation in 2 cases (34%). Mean gradients were reduced to 4.2 ± 0.6 mm Hg (mean EOA, 2.8 ± 0.4 cm2). No patient had a stroke during hospitalization, and 30-day mortality was seen in 1 patient (17%) resulting from pneumonia. CONCLUSIONS TMV implantation using the SAPIEN 3 aortic prosthesis in patients with heavy annular calcification is feasible and represents a reasonable bailout option for inoperable patients. However, several limitations need to be considered in this special patient population.
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Affiliation(s)
- Philipp Kiefer
- Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany.
| | - Thilo Noack
- Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany
| | - Joerg Seeburger
- Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany
| | - Alexandro Hoyer
- Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany
| | - Axel Linke
- Department of Cardiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Norman Mangner
- Department of Cardiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Lukas Lehmkuhl
- Department of Radiology, University of Leipzig Heart Center, Leipzig, Germany
| | | | - David Holzhey
- Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany
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12
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Abstract
Because of high exposure (e. g. swimmers and athletes competing on mats) and disposition (e. g. microtraumata of the skin in runners) athletes are prone to a higher risk for mycotic infections by dermatophytes. In disciplines with close contact during competition-especially wrestlers and judoists-infections by the anthropophilic Trichophyton (T.) tonsurans are most important (tinea gladiatorum). These infections are highly contagious and often cause small epidemics especially if the primary source of infection is not promptly recognized. The environment of the athletes (e. g. mats) and asymptomatic carriers may be sources of further spread. Tinea pedis with its clinical manifestations seems to be often underdiagnosed and insufficiently treated. Environmental contamination by fungal spores may be responsible for the significantly higher level of mycotic infections of the feet in children and adolescents active in sports. There is a higher risk for spread of the infection to the toe nails (onychomycosis) and for consecutive infections by bacteria (e. g. erysipelas). More rarely infections by zoophilic or geophilic dermatophytes are seen in athletes (e.g. equestrians). Education and more intensive measures of prevention and environmental decontamination are essential for all dermatophytoses associated with sports.
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Affiliation(s)
- P Mayser
- , Hofmannstr. 11, 35444, Biebertal, Deutschland.
| | - W Handrick
- Institut für Medizinische Diagnostik Oderland, Frankfurt (Oder), Deutschland
| | - P Nenoff
- Labor für medizinische Mikrobiologie, Mölbis, Deutschland
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Sharma J, Goel PK, Pandey CM, Awasthi A, Kapoor A, Tewari S, Garg N, Kumar S, Khanna R. Intermediate outcomes of rheumatic mitral stenosis post-balloon mitral valvotomy. Asian Cardiovasc Thorac Ann 2015. [DOI: 10.1177/0218492315598240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosis. Data on intermediate outcomes of this procedure are limited. Thus we investigated the intermediate outcome after balloon mitral valvotomy performed at a large tertiary center in India. Methods Case records and follow-up data of 2330 patients who underwent valvotomy from June 1999 to December 2005 were retrieved from the hospital information system and analyzed. Results The median age of the patients was 32 ± 11 years, 1363 were female including 36 who were pregnant, and 379 were in atrial fibrillation. Follow-up ranged from 1 to 14 years (mean 4.5 years, median 4.0 years). The procedural success rate was 93%. Atrial fibrillation, higher functional class, and worse valve morphology were independent predictors of a poor procedural outcome. Patients with sinus rhythm had better event-free survival (10.43 years, 95% confidence interval: 10.1–10.7) compared to those with atrial fibrillation (8.17 years, 95% confidence interval: 7.5–8.8). Patients who achieved a valve area >1.75 cm2 had a better event-free survival (11.7 years, 95% confidence interval: 11.4–12.0) than those with a valve area of 1.5–1.74 cm2 (9.3 years, 95% confidence interval: 9.0–9.7). On multivariate analysis, higher functional class, worse valve morphology, and new significant mitral regurgitation were predictors of a poor outcome. Achieved mitral valve area >1.75 cm2 was an independent predictor of a good outcome. Conclusion Patients with sinus rhythm, less gross valve deformity, and a post-balloon mitral valvotomy area >1.75 cm2 had better intermediate outcomes.
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Affiliation(s)
- Jugal Sharma
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Pravin K Goel
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | | | - Ashish Awasthi
- Department of Biostatistics, Sanjay Gandhi PGIMS, Lucknow, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | | | - Naveen Garg
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India
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Killu AM, Wan SH, Munger TM, Hodge DO, Mulpuru S, Packer DL, Asirvatham SJ, Friedman PA. Pericardial effusion following drain removal after percutaneous epicardial access for an electrophysiology procedure. Pacing Clin Electrophysiol 2015; 38:383-90. [PMID: 25583074 DOI: 10.1111/pace.12565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/10/2014] [Accepted: 11/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the frequency and predictors of pericardial effusion following epicardial sheath removal. BACKGROUND Pericardial effusion can occur following cardiac surgical or interventional procedures including percutaneous epicardial access (EpiAcc), which is increasingly used as part of electrophysiology ablation procedures. METHODS A retrospective analysis of the Mayo Clinic comprehensive electronic medical record was performed from all patients who underwent planned EpiAcc as part of an electrophysiology ablation procedure between January 1, 2004 and June 30, 2013. RESULTS Of 144 patients (mean age 51.3 ± 15.5 years, 68% male) who underwent planned EpiAcc as part of an electrophysiology ablation (95.8% pericardial access success rate), seven (4.9%) developed a postoperative pericardial effusion requiring repeat EpiAcc. Inferior access was utilized in 74 (51.4%) patients. Patients with pericardial effusion tended to be younger (41.1 years vs 51.8 years, P = 0.08) and were more likely to have undergone inferior approach access (85.7% vs 49.6%, P = 0.06) than those who did not develop postoperative pericardial effusion. Seventy-one percent of patients with postoperative pericardial effusion versus 32.1% of patients without postoperative pericardial effusion had a preprocedure ejection fraction ≥55% (P = 0.03). There were no procedural-related deaths, and no difference in mortality between groups. CONCLUSIONS Postoperative pericardial effusion requiring repeat access/drainage was relatively infrequent, occurring in 4.9% of patients shortly after epicardial procedures. While the majority occur early and therefore require close observation, some patients may present in a delayed manner.
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Affiliation(s)
- Ammar M Killu
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Doukky R, Abusin SA, Bayissa YA, Kelly RF, Ansari AH. Rheumatic heart disease in modern urban america: A cohort study of immigrant and indigenous patients in Chicago. Int J Cardiol 2014; 175:178-80. [DOI: 10.1016/j.ijcard.2014.04.207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 04/19/2014] [Indexed: 11/25/2022]
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Eng MH, Salcedo EE, Kim M, Quaife RA, Carroll JD. Implementation of real-time three-dimensional transesophageal echocardiography for mitral balloon valvuloplasty. Catheter Cardiovasc Interv 2013; 82:994-8. [DOI: 10.1002/ccd.25052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/23/2013] [Accepted: 06/01/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Marvin H. Eng
- Department of Medicine, Division of Cardiology, University of Texas Health Sciences Center; San Antonio Texas
| | - Ernesto E. Salcedo
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - Michael Kim
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - Robert A. Quaife
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - John D. Carroll
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
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Tuzcu EM, Kapadia SR. Long-term efficacy of percutaneous mitral commissurotomy for recurrent mitral stenosis. Heart 2013; 99:1307-8. [DOI: 10.1136/heartjnl-2013-304135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bouleti C, Iung B, Himbert D, Brochet E, Messika-Zeitoun D, Détaint D, Garbarz E, Cormier B, Vahanian A. Reinterventions after percutaneous mitral commissurotomy during long-term follow-up, up to 20 years: the role of repeat percutaneous mitral commissurotomy. Eur Heart J 2013; 34:1923-30. [DOI: 10.1093/eurheartj/eht097] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Nair KKM, Pillai HS, Thajudeen A, Krishnamoorthy KM, Sivasubramonian S, Namboodiri N, Sasidharan B, Ganapathy S, Varaparambil A, Titus T, Tharakan J. Immediate and long-term results following balloon mitral valvotomy in patients with atrial fibrillation. Clin Cardiol 2012; 35:E35-9. [PMID: 23124930 DOI: 10.1002/clc.22068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/28/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the influence of atrial fibrillation (AF) on the immediate and long-term outcome of patients undergoing balloon mitral valvotomy (BMV). HYPOTHESIS Patients with atrial fibrillation fair poorly after balloon mitral valvotomy. METHODS There were a total of 818 consecutive patients who underwent elective BMV in this institute from 1997 to 2003, with either double-lumen or triple-lumen BMV catheters included in the study. Of them, 95 were with AF. The clinical, echocardiographic, and hemodynamic data of these patients were compared with those of 723 patients in normal sinus rhythm (NSR). Immediate procedural results and long-term events were compared between the 2 study groups. RESULTS Patients with AF were older (39.9 ± 9.9 years vs 29.4 ± 10.1, P < 0.001) and presented more frequently with New York Heart Association (NYHA) class III-IV (53.7% vs 32.9%, P < 0.001), echocardiographic score >8 (47.4% vs 24.9%, P < 0.001), and with history of previous surgical commissurotomy (33.7% vs 11.5%, P < 0.001). In patients with AF, BMV resulted in inferior immediate and long-term outcomes, as reflected in a lesser post-BMV mitral valve area (1.3 ± 0.4 vs 1.6 ± 0.4 cm(2), P = 0.032) and higher event rate on follow-up. CONCLUSIONS Patients with AF were older, sicker, and had advanced rheumatic mitral valve disease. They had a higher incidence of stroke, new onset heart failure, and need for reinterventions on long-term follow-up. These patients need intense and more frequent follow-up.
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Affiliation(s)
- Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Bouleti C, Iung B, Laouénan C, Himbert D, Brochet E, Messika-Zeitoun D, Détaint D, Garbarz E, Cormier B, Michel PL, Mentré F, Vahanian A. Late results of percutaneous mitral commissurotomy up to 20 years: development and validation of a risk score predicting late functional results from a series of 912 patients. Circulation 2012; 125:2119-27. [PMID: 22456478 DOI: 10.1161/circulationaha.111.055905] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Long-term follow-up after percutaneous mitral commissurotomy enables predictive factors of late results to be identified. METHODS AND RESULTS Late results of percutaneous mitral commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm(2) without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral commissurotomy and in New York Heart Association class I or II) was 30.2 ± 2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient (P<0.0001), interaction between age and final mitral valve area (P<0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification (P<0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation (P<0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort. CONCLUSIONS Twenty years after percutaneous mitral commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.
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Affiliation(s)
- Claire Bouleti
- Cardiology Department, AP-HP, Bichat Hospital, Paris, France
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Palacios IF, Arzamendi D. Percutaneous Mitral Balloon Valvuloplasty for Patients with Rheumatic Mitral Stenosis. Interv Cardiol Clin 2012; 1:45-61. [PMID: 28582067 DOI: 10.1016/j.iccl.2011.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Percutaneous balloon dilatation of stenotic cardiac valves is used for the treatment of pulmonic, mitral, aortic, and tricuspid stenosis. Percutaneous mitral balloon valvuloplasty (PMV) has been used successfully as an alternative to open or closed surgical mitral commissurotomy in the treatment of symptomatic rheumatic mitral stenosis. PMV produces good immediate hemodynamic outcome, low complication rates, and clinical improvement in the majority of patients. PMV is safe and effective and provides clinical and hemodynamic improvement in rheumatic mitral stenosis. PMV is the preferred form of therapy for relief of mitral stenosis for a selected group of patients with symptomatic mitral stenosis.
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Affiliation(s)
- Igor F Palacios
- Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Dabit Arzamendi
- Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
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Nair K, Sivadasanpillai H, Sivasubramonium P, Ramachandran P, Tharakan JA, Titus T, Ajit Kumar VK, Sivasubramonian S, Krishnamoorthy KM, Dora S. Percutaneous valvuloplasty for mitral valve restenosis: postballoon valvotomy patients fare better than postsurgical closed valvotomy patients. Catheter Cardiovasc Interv 2010; 76:174-80. [PMID: 20232411 DOI: 10.1002/ccd.22510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM To compare the results of percutaneous mitral valvuloplasty (BMV) for mitral restenosis in post-BMV versus postclosed mitral valvotomy (CMV) patients. METHODS AND RESULTS Ninety-two patients who underwent BMV for mitral restenosis were followed up prospectively. Of these, 28 patients had undergone previous percutaneous mitral valvuloplasty (PRIOR BMV) and 64 patients had undergone previous closed mitral valvotomy (PRIOR CMV). BMV for mitral restenosis was a success in 59% patients (57.1% PRIOR BMV, 59.3% PRIOR CMV, P = 1.0). Incidence of severe mitral regurgitation was 3.25%, all in the PRIOR CMV group. In univariate analysis, the major predictor of successful BMV for mitral restenosis was Wilkins score (P = 0.004). At a follow up of 3.47 + 2.07 years, mitral valve area was similar between groups (1.45 +/- 0.22, 1.46 +/- 0.26, P = 0.35). The combined end points of mitral valve replacement (MVR), need for re-repeat BMV for mitral restenosis or death was higher in the PRIOR CMV group (31.2% PRIOR CMV, 7.1% PRIOR BMV, P = 0.027). Event-free survival at follow up was lower in the PRIOR CMV group (69% PRIOR CMV, 92.8% PRIOR BMV) mainly due to the higher need for MVR (11 vs. 0 patients, P = 0.03). CONCLUSIONS In conclusion, following BMV for mitral restenosis, patients with PRIOR BMV are found to have lesser event rates on follow-up compared to patients with PRIOR CMV, though procedural success rates are similar.
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Affiliation(s)
- Krishnakumar Nair
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Yazıcıoğlu N, Arat Özkan A, Orta Kılıçkesmez K, Çeliker C, Mert M, Pehlivanoglu S, Enar R, Karatay C, Küçükoğlu S. Immediate and Follow-Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First Procedure. Echocardiography 2010; 27:765-9. [DOI: 10.1111/j.1540-8175.2010.01150.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Song JK, Kim MJ, Yun SC, Choo SJ, Song JM, Song H, Kang DH, Chung CH, Park DW, Lee SW, Kim YH, Lee CW, Hong MK, Kim JJ, Lee JW, Park SW, Park SJ. Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery. J Thorac Cardiovasc Surg 2010; 139:103-10. [DOI: 10.1016/j.jtcvs.2009.04.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 04/03/2009] [Accepted: 04/23/2009] [Indexed: 11/26/2022]
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Fawzy ME. Long-Term Results up to 19 Years of Mitral Balloon Valvuloplasty. Asian Cardiovasc Thorac Ann 2009; 17:627-33. [DOI: 10.1177/0218492309349258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical and echocardiographic data of 547 consecutive patients (mean age, 31.5 years) undergoing mitral balloon valvuloplasty with follow-up of 1.5–19 years, were analyzed. Immediately after valvuloplasty, mitral valve area increased significantly from 0.92 ± 0.17 to 1.95 ± 0.29 cm2. Restenosis occurred in 169 (31%) patients; it was less common (20%) in those with a mitral echocardiographic score ≤8. Actuarial freedom from restenosis at 10, 15, and 19 years was 78% ± 2%, 52% ± 3%, and 26 ± 4%, respectively, and significantly higher in patients with echocardiographic scores ≤8: 88% ± 2%, 67% ± 4%, and 40% ± 6%, respectively. Event-free survival at 10, 15, and 19 years was 88% ± 2%, 60% ± 4%, and 28% ± 7%, respectively, and significantly higher in patients with echocardiographic scores ≤8: 92% ± 1%, 70% ± 4%, and 42% ± 7%, respectively. Multivariate analysis identified echocardiographic score ≤8 and post-procedure valve area ≤1.8 as predictors of restenosis, and echocardiographic score > 8 and preexisting atrial fibrillation as predictors of combined events. Valvuloplasty provides excellent results in selected patients with mitral stenosis. The long-term outcome can be predicted from the baseline characteristics of the mitral valve.
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Rifaie O, Ismail M, Nammas W. Immediate and long-term outcome of redo percutaneous mitral valvuloplasty: comparison with initial procedure in patients with rheumatic mitral restenosis. J Interv Cardiol 2009; 23:1-6. [PMID: 19843203 DOI: 10.1111/j.1540-8183.2009.00508.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS We explored the immediate and long-term outcome of redo percutaneous mitral valvuloplasty (PMV) in a series of patients with mitral restenosis in comparison with initial PMV in the same series. METHODS We enrolled 40 consecutive patients presenting with mitral restenosis after successful initial PMV. Redo PMV was performed by the antegrade transseptal approach using either the Inoue technique or the multitrack technique. Reassessment by transthoracic echocardiography was repeated 48 hours later, and annually thereafter. Procedural success was defined as 50% or more increase of mitral valve area (MVA) with a final MVA >or=1.5 cm(2), without major complications. Restenosis was defined as loss of >50% of the initial gain of MVA by the preceding PMV with a final MVA <1.5 cm(2). RESULTS Procedural success was achieved in 37 (92.5%) patients. Both the initial and redo procedures were similar concerning the final MVA and mean transmitral pressure gradient (P > 0.05 for all). The gain of MVA was higher in the initial as compared to the redo procedure (P < 0.001). The initial mitral valve score correlated negatively with the final MVA in both the initial and redo procedures, and was the only independent predictor of the time to redo procedure, by multivariate regression analysis. At long-term follow-up (61 +/- 2.8 months), the mean MVA was 1.6 +/- 0.3 cm(2). Three patients--out of 12 available for follow-up--developed restenosis. CONCLUSION Redo PMV for mitral restenosis is feasible, safe, and achieves immediate and long-term outcome comparable to initial PMV.
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Affiliation(s)
- Osama Rifaie
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
Mitral stenosis is a common disease that causes substantial morbidity worldwide. The disease is most prevalent in developing countries, but is increasingly being identified in an atypical form in developed countries. All treatments that increase valve area improve morbidity. Mortality improves with surgery; the benefit of percutaneous balloon valvuloplasty to mortality might be similar to that of surgery but needs further study. Percutaneous balloon valvuloplasty is the treatment of choice for patients in whom treatment is indicated, except for those with suboptimum valve morphology, and even these patients are sometimes treated with this procedure if surgery is not feasible or if surgical risk is prohibitive. We review the pathology, diagnosis, and treatment options for patients with mitral stenosis.
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Affiliation(s)
- Y Chandrashekhar
- Veterans Affairs Medical Center and University of Minnesota, Minneapolis, MN 55417, USA.
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Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era. JACC Cardiovasc Interv 2009; 2:705-17. [DOI: 10.1016/j.jcin.2009.04.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 04/03/2009] [Indexed: 11/20/2022]
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Song JK, Song JM, Kang DH, Yun SC, Park DW, Lee SW, Kim YH, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Restenosis and adverse clinical events after successful percutaneous mitral valvuloplasty: immediate post-procedural mitral valve area as an important prognosticator. Eur Heart J 2009; 30:1254-62. [PMID: 19346230 DOI: 10.1093/eurheartj/ehp096] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS We sought to investigate the factors associated with restenosis and its potential association with late clinical deterioration after successful percutaneous mitral valvuloplasty (PMV). METHODS AND RESULTS We analysed echocardiographic (median 74 months) and clinical (median 109 months) follow-up data of 329 patients who achieved procedural success, defined as mitral valve area (MVA) > or =1.5 cm(2) and mitral regurgitation (MR) < or =2/4, between 1995 and 2000. Clinical events included cardiovascular death, mitral valve surgery, and repeat PMV. The 1, 3, 5, 7, and 9 year rates of restenosis-free survival were 99 +/- 1%, 97 +/- 1%, 95 +/- 1%, 86 +/- 3%, and 72 +/- 4%, respectively. The 1, 3, 5, 7, and 9 year rates of event-free survival were 99.7 +/- 0.3%, 96.4 +/- 1.0%, 94.5 +/- 1.3%, 90.8 +/- 1.6%, and 90.0 +/- 1.7%, respectively. Immediate post-PMV MVA and commissural MR or splitting, indicators of procedural adequacy, were independent predictors of both restenosis and clinical events. The best immediate post-PMV MVA cut-off value for predicting both restenosis and clinical events within 5 years after successful PMV were 1.8 cm(2) [95% confidence interval (CI) = 1.7-1.9] and 1.9 cm(2) (95% CI = 1.7-2.0), respectively. Patients with immediate post-PMV MVA <1.8 cm(2) showed significantly lower event-free survival rate than those with post-PMV MVA > or =1.8 cm(2) (P < 0.001). CONCLUSION Immediate post-PMV MVA> or =1.8 cm(2) was an important predictor of both restenosis- and clinical event-free survival and this value should be considered as a component of optimal result.
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Affiliation(s)
- Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-ku, Seoul 138-736, South Korea.
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O'Gara PT, O'Rourke RA, Shah PM. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52:e1-142. [PMID: 18848134 DOI: 10.1016/j.jacc.2008.05.007] [Citation(s) in RCA: 1057] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523-661. [PMID: 18820172 DOI: 10.1161/circulationaha.108.190748] [Citation(s) in RCA: 802] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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FAWZY MOHAMEDEID, STEFADOUROS MILTIADIS, AMRAOUI SOUADEL, OSMAN ADIL, IBRAHIM IMAN, NOWAYHED OMAR, ELDALI ABDELMONEIM, CANVER CHARLES. Long-Term (Up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in Children in Comparison with Adult Population. J Interv Cardiol 2008; 21:252-9. [DOI: 10.1111/j.1540-8183.2008.00357.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Tanaka S, Watanabe S, Matsuo H, Segawa T, Iwama M, Hirose T, Takahashi H, Ono K, Warita S, Kojima T, Minatoguchi S, Fujiwara H. Over 10 years clinical outcomes in patients with mitral stenosis with unilateral commissural calcification treated with catheter balloon commissurotomy: Single-center experience. J Cardiol 2008; 51:33-41. [DOI: 10.1016/j.jjcc.2007.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 10/16/2007] [Accepted: 10/17/2007] [Indexed: 11/27/2022]
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Fawzy ME, Shoukri M, Hassan W, Nambiar V, Stefadouros M, Canver CC. The impact of mitral valve morphology on the long-term outcome of mitral balloon valvuloplasty. Catheter Cardiovasc Interv 2007; 69:40-6. [PMID: 17139606 DOI: 10.1002/ccd.20936] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of mitral valve morphology (MVM) on the long-term results of mitral balloon valvuloplasty (MBV) is not well established. The aim of the study was to evaluate the impact of MVM on long-term outcome of MBV. METHODS Five hundred and eighteen consecutive patients (mean age, 31+/-11 years) who underwent successful MBV were followed up for 0.5-16.5 (mean, 6+/-4.5) years. Patients were divided into two groups according to their mitral echo score (MES) before MBV: group A (n=340; MES<or=8) and group B (n=178; MES>8). RESULTS We report the immediate and long-term clinical and echocardiographic results of the above-mentioned 518 consecutive patients. The mitral valve area was significantly larger in group A than in group B, both immediately after MBV (2.0+/-0.3 vs. 1.82+/-0.3 cm2, respectively; P<0.0001) and also at the last follow-up (1.8+/-0.33 vs. 1.5+/-0.33 cm2, respectively; P<0.0001). Restenosis occurred in 38/340 (11%) in group A vs. 73/178 (41%) in group B (P<0.0001). Actuarial freedom from restenosis at 5, 10, 15 years were 92+/-2%, 85+/-3%, 65+/-6% for group A vs. 72+/-4%, 44+/-5%, 9+/-6% for group B (P<0.001). Event-free survival rates at 5, 10, 15 years for group A were 93+/-1%, 88+/-2%, 66+/-6% vs. 82+/-3%, 59+/-6%, 8+/-7% for group B (P<0.0001). Stepwise Cox multivariate regression analysis identified MES, preprocedure functional class, and postprocedure mitral valve area<or=1.8 cm2, as predictors of restenosis (P<0.0001, P=0.014, P=0.0015, respectively); MES and age as predictors of event-free survival (P<0.0001, P<0.0001, respectively). CONCLUSION MBV has excellent long-term results in patients with favorable MVM. Favourable MVM is a strong predictor of good long-term outcome.
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Affiliation(s)
- Mohamed Eid Fawzy
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Fawzy ME, Fadel B, Al-Sergani H, Al Amri M, Hassan W, Abdulbaki K, Shoukri M, Canver C. Long-Term Results (Up to 16.5 Years) of Mitral Balloon Valvuloplasty in a Series of 518 Patients and Predictors of Long-Term Outcome. J Interv Cardiol 2007; 20:66-72. [PMID: 17300407 DOI: 10.1111/j.1540-8183.2007.00212.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To assess the long-term results (up to 16.5 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival. METHODS AND RESULTS We report the immediate and long-term clinical and echocardiographic results in 518 patients, mean age 31 +/- 11 years, who underwent successful MBV for severe mitral stenosis (MS) and were followed up for 0.5-16.5 (mean 6 +/- 4.5) years. After MBV, mitral valve area (MVA) increased from 0.84 +/- 0.2 to 1.83 +/- 0.53 cm(2) (P < 0.0001) as measured by catheter and from 0.92 +/- 0.17 to 1.96 +/- 0.29 cm(2) (P < 0.0001) as measured by two-dimensional echo. Restenosis occurred in 111 patients (21%) and it was less frequent in patients with low echo score (11%). Actuarial freedom from restenosis at 5, 10, 15 years was 85 +/- 1%, 70 +/- 3%, and 44 +/- 5%, respectively, and was significantly higher in patients with low echo score. Event-free survival (death, redo MBV, mitral valve replacement, New York Heart Association [NYHA] functional class III or IV) at 5, 10, 15 years was 89 +/- 1%, 79 +/- 2%, 43 +/- 9%, respectively, and was significantly higher for patients with low echo score. Cox regression analysis identified mitral echocardiographic score (MES) > 8 (P < 0.0001), postprocedure mitral valve area (MVA) (P = 0.0015), and preprocedure functional class (P = 0.014) as predictors of restenosis and MES (P < 0.0001) and age (P < 0.0001) and postprocedure MVA (P = 0.015) as predictors of event-free survival. CONCLUSIONS MBV provides excellent long-term results for selected patients with MS. The long-term outcome after this procedure can be predicted from baseline clinical and echocardiographic characteristics.
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Affiliation(s)
- Mohamed E Fawzy
- King Faisal Heart Institute (MBC 16), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Balloon Dilatation of the Cardiac Valves. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Cohn WE, Frazier OH, Cooley DA. Valvular Heart Disease: Surgical Treatment. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Yilmaz MB, Demirkan B, Caldir V, Guray Y, Guray U, Sasmaz H, Korkmaz S. Association of lipid profile with echocardiographic Wilkins score in patients with moderate to severe mitral stenosis: possible impact on prognosis. Int J Cardiol 2006; 112:329-33. [PMID: 16290100 DOI: 10.1016/j.ijcard.2005.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 07/25/2005] [Accepted: 10/02/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Association of valvular heart disease and lipid profile might be important as in the case of aortic stenosis. However, it has not been so far considered in detail the probable association of other valvular diseases, particularly of mitral stenosis (MS) with lipid profile. In our study, we aimed to search possible association of echocardiographic mitral valve score, evaluated according to Wilkins score, with lipid parameters in a group of patients with mitral stenosis, who were referred for possible percutaneous balloon valvuloplasty. MATERIAL AND METHOD We retrospectively reviewed 401 patients (316 female, 85 male), who were referred as possible candidates for PMBV, with moderate to severe MS of predominantly rheumatic origin. Mitral valve was evaluated according to Wilkins score by an experienced author as indicated. RESULTS Mean age of all patients was 36.6+/-11.3 years, and was not different in both genders. Mean mitral valve area was 1+/-0.1 mm2. Considering all patients, total Wilkins score was significantly, but mildly correlated with ratio of total/HDL cholesterol ratio (r=0.174, p=0.02). Presence of more than one recurrent attack of rheumatic fever, narrow mitral valve area, high total/HDL cholesterol and being male were independent predictors of poor echocardiographic Wilkins score (>8). CONCLUSION We think that Wilkins echocardiographic score of mitral stenosis, particularly of leaflet thickening, might well be associated with serum lipids, probably as the same extent does aortic stenosis.
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Affiliation(s)
- Mehmet Birhan Yilmaz
- Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Sihhiye, Ankara, Turkey.
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48:e1-148. [PMID: 16875962 DOI: 10.1016/j.jacc.2006.05.021] [Citation(s) in RCA: 1091] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bonow RO, Carabello BA, Kanu C, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 2006; 114:e84-231. [PMID: 16880336 DOI: 10.1161/circulationaha.106.176857] [Citation(s) in RCA: 1387] [Impact Index Per Article: 77.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.05.030] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Maoqin S, Guoxiang H, Zhiyuan S, Luxiang C, Houyuan H, Liangyi S, Ling Z, Guoqiang Z. The clinical and hemodynamic results of mitral balloon valvuloplasty for patients with mitral stenosis complicated by severe pulmonary hypertension. Eur J Intern Med 2005; 16:413-8. [PMID: 16198900 DOI: 10.1016/j.ejim.2005.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2004] [Revised: 01/11/2005] [Accepted: 02/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Percutaneous balloon mitral valvuloplasty (PBMV) has become the procedure of choice for isolated, uncomplicated mitral stenosis (MS) with favorable morphology and may be a useful method for surgical high-risk conditions such as advanced age, the presence of severe tricuspid regurgitation, New York Heart Association (NYHA) class IV at presentation, and severe pulmonary hypertension (PH). The development of PH is a common and important sequela in patients with advanced mitral stenosis and is associated with hemodynamic and clinical decompensation. However, the influence of PBMV on patients with severe PH has seldom been evaluated. Our objective was to probe into the immediate and long-term effects of PBMV on patients with MS complicated by severe PH and to predict the factors that determine the prognosis of patients with severe PH. METHODS We included 44 patients with MS complicated by severe PH (systolic pulmonary pressure >80 mm Hg, group S) and 67 patients with MS complicated by mild PH (systolic pulmonary pressure <50 mm Hg, group M) in this study and we compared their immediate and late results after a follow-up period of 24 months after PBMV. RESULTS Compared with group M, patients in group S were older, presented more frequently with NYHA III-IV class, valvular echo score >or=8, and more severe tricuspid regurgitation, and had a bigger left atrial diameter before PBMV. The successful rate and the incidence of severe complications from the PBMV procedure were similar in both groups. There were more cases of post-PBMV mitral valve area >or=1.5 cm(2) in group M than in group S, and the average mitral valve area in group M was somewhat larger than that of group S. After PBMV, NYHA class obviously improved in both groups, but there were more patients with NYHA<or=class II in group M than in group S at discharge. During the 24-month follow-up, 7 patients (10.5%) in group M and 11 (25.0%) in group S developed cardiac events (p<0.1). Cumulative event-free survival was 89.6% in group M and 75.0% in group S (p>0.05). NYHA class I or II was present for 80.6% in group M and 59.1% in group S (p<0.10). RESULTS PBMV is a safe and effective procedure for patients with severe PH. It can remarkably improve clinical outcomes, although hemodynamic effects of PBMV on this subgroup are not complete. Pre-existing older age, more severe valvular lesion and tricuspid regurgitation, worse cardiac function, and bigger left atrial size in patients with severe PH may be important risk factors for the poor hemodynamic outcomes of PBMV.
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Affiliation(s)
- Shu Maoqin
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Sanchez PL, Rodriguez-Alemparte M, Inglessis I, Palacios IF. The Impact of Age in the Immediate and Long-Term Outcomes of Percutaneous Mitral Balloon Valvuloplasty. J Interv Cardiol 2005; 18:217-25. [PMID: 16115149 DOI: 10.1111/j.1540-8183.2005.00045.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Differences in age, clinical characteristics, and valve morphology may account for controversial results of percutaneous mitral balloon valvuloplasty (PMV). METHODS We have previously reported the immediate and long-term clinical follow-up (50 +/- 45 months) of 879 patients who underwent PMV at the Massachusetts General Hospital. In the present study, we used this database to determine the impact of age in the immediate and long-term outcome of PMV. For purpose of analysis, these patients were divided into four age groups: group 1 (< or =35 years), group 2 (36-55 years), group 3 (56-75 years), and group 4 (>75 years). RESULTS The incidence of atrial fibrillation, calcified valves under fluoroscopy, higher echocardiographic score, New York Heart Association (NYHA) class IV and pre-PMV mitral regurgitation (MR) increased with patient's age. As patients became older, a lower post-PMV mitral valve area (2.1 +/- 0.7, 2.0 +/- 0.6, 1.8 +/- 0.6, and 1.6 +/- 0.6; P < 0.0001) and progressive decrease in procedural success (81.4%, 80.5%, 65.3%, and 53%; P < 0.0001) were observed. Younger age was identified as an independent predictor of PMV success by multiple stepwise logistic regression (odds ratio [OR]: 3.33; confidence interval [CI]: 1.41-7.69, P = 0.006). Furthermore, age was identified as an independent predictor of long-term events by Cox regression analysis (risk ratio [RR]: 1.02; CI: 1.01-1.03, P < 0.00001). However, the effect of age seemed to be blunted by the morphology of the valve at follow-up, as patients with echocardiogram score >8 in groups 2, 3, and 4 presented similar combined event-free survival (death, mitral valve replacement, or redo PMV). CONCLUSION Age is an important predictor of immediate and long-term outcomes after PMV, particularly in patients with optimal mitral valve morphology. (
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Affiliation(s)
- Pedro L Sanchez
- Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Fawzy ME, Stefadouros MA, Hegazy H, Shaer FE, Chaudhary MA, Fadley FA. Long term clinical and echocardiographic results of mitral balloon valvotomy in children and adolescents. Heart 2005; 91:743-8. [PMID: 15894766 PMCID: PMC1768960 DOI: 10.1136/hrt.2004.040766] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
AIMS To assess the safety, efficacy, and long term results of mitral balloon valvotomy (MBV) for rheumatic mitral stenosis in children and adolescents in comparison to adults. METHODS The results of 468 patients with mitral stenosis who underwent successful MBV and were followed up for 0.5-13 years were analysed. Patients were divided according to age at the time of MBV into group 1 consisting of 84 patients < or = 20 years of age (children and adolescents) and group 2 that included 384 patients, age > 20 (adults). RESULTS Patients in group 1 had a lower mitral echo score (mean (SD) 7.5 (1.3) v 8 (1.1), p < 0.001), smaller Doppler mitral valve area (MVA) (0.84 (0.17) v 0.92 (0.18) cm2, p < 0.001), and higher Doppler mitral valve gradient (15.0 (5.3) v 12.7 (4.5) mm Hg, p < 0.001) than group 2. Immediately after MBV group 1 had larger MVA, whether measured by Doppler (2.0 (0.30) v 1.96 (0.28) cm2, p < 0.05) or by catheter (2.0 (0.59) v 1.8 (0.52) cm2, p < 0.001), and similar complication rates, compared to group 2. After a mean follow up of 5 (3.5) years there was no significant difference between groups 1 and 2 in the incidence of restenosis (14.3% v 16.1%, NS). Event-free survival rates at 5, 10, and 12.5 years were 93%, 79%, and 79% for group 1 and 94%, 90%, and 84% for group 2 (p = 0.18). CONCLUSIONS MBV is safe and effective in children and adolescents with rheumatic mitral stenosis. It provides better immediate results than in adults and excellent long term results that are comparable to those seen in adults.
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Affiliation(s)
- M E Fawzy
- Department of Cardiovascular Diseases and the Department of Biostatistics, Epidemiology, King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia.
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Fawzy ME, Hegazy H, Shoukri M, El Shaer F, ElDali A, Al-Amri M. Long-term clinical and echocardiographic results after successful mitral balloon valvotomy and predictors of long-term outcome. Eur Heart J 2005; 26:1647-52. [PMID: 15821007 DOI: 10.1093/eurheartj/ehi226] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the long-term outcome of mitral balloon valvotomy (MBV) and identify predictors of restenosis- and event-free survival. METHODS AND RESULTS We report the immediate and long-term clinical and echocardiographic results in 493 patients, mean age 31+/-11, who underwent successful MBV and were followed-up for 0.5-15 years (median 5+/-3) with clinical and echocardiographic examination. After MBV, mitral valve area increased from 0.84+/-0.2 to 1.83+/-0.53 cm(2) (P<0.0001) as measured by catheter and from 0.92+/-0.17 to 1.96+/-0.29 cm(2) as measured by two-dimensional echo. Restenosis occurred in 86/493 (17.4%) patients and it was less frequent in patients with low echo score. Actuarial freedom from restenosis at 5, 7, 10, and 13 years were 89+/-1, 81+/-2, 68+/-3, and 51+/-6%, respectively, and was significantly higher in patients with low echo score. Event-free survival (death, redo MBV, mitral valve replacement, New York Heart Association functional Class III or IV) at 5, 7, 10, and 13 years were 92+/-1, 87+/-2, 80+/-3, and 74+/-3%, respectively, and was significantly higher for patients with low echo score. Cox regression analysis identified mitral echocardiographic score (MES) >8 as predictors of restenosis (P=0.0004) and MES and age as predictors of event-free survival (P=0.0003 and 0.004, respectively). CONCLUSION MBV has excellent long-term results for selected patients with mitral stenosis. The long-term outcome after this procedure can be predicted from baseline clinical and valvular characteristics.
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Affiliation(s)
- Mohamed Eid Fawzy
- Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia.
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Ates A, Unlü Y, Yekeler I, Erkut B, Balci AY, Ozyazicioglu A, Koçak H. Role of closed mitral commissurotomy for mitral stenosis: mid- and long-term surgical outcome of 36 patients. Heart Surg Forum 2005; 8:E55-9. [PMID: 15769718 DOI: 10.1532/hsf98.20041137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. MATERIAL AND METHODS Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 +/- 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours +/- 30 minutes. RESULTS After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm(2). No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade >or=3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. CONCLUSIONS The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.
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Affiliation(s)
- Azman Ates
- Department of Cardiovascular Surgery, Atatürk University School of Medicine, Erzurum, Turkey.
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Wright DJ, Williams SG, Tzeng BH, Marshall P, Mackintosh AF, Tan LB. Does balloon mitral valvuloplasty improve cardiac function? A mechanistic investigation into impact on exercise capacity. Int J Cardiol 2003; 91:81-91. [PMID: 12957733 DOI: 10.1016/s0167-5273(02)00591-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Procedural technical success of balloon mitral valvuloplasty (BMV) is indicated by an increase in valve area and a reduction in transvalvar gradient, but there are conflicting results regarding whether these indicators correlate with subsequent improvements in exercise capacity. We conducted a study to explore the effects of valvuloplasty on cardiac function to gain insight into the mechanisms responsible for the impact on exercise ability. Sixteen patients with mitral stenosis participated in the study and the five who did not proceed to valvuloplasty served as the control group. All patients performed maximal cardiopulmonary exercise tests before and 6 weeks after valvuloplasty (without valvuloplasty in controls). Central haemodynamics including cardiac output were measured non-invasively at rest and peak exercise. At baseline, the cardiopulmonary exercise test results were similar in the two groups. Following valvuloplasty, cardiac output did not alter at rest, but increased significantly at peak exercise (8.7+/-1.7 to 10.5+/-2.1 l min(-1), P<0.01), as did peak cardiac power output (1.88+/-0.55 to 2.28+/-0.74, P<0.05) and cardiac reserve (1.07+/-0.33 to 1.45+/-0.55 watts, P<0.05). Aerobic exercise capacity improved (13.9+/-4.2 to 16.4+/-4.3 ml kg(-1) min(-1), P<0.01) as did exercise duration (354+/-270 to 500+/-266 s, P<0.01). There were no significant changes in the controls. There was a significant correlation between the changes in peak VO(2) and changes in cardiac reserve (r=0.62, P<0.01) but not with changes in resting haemodynamics. These changes did not correlate with changes in peri-procedural mitral valve haemodynamics, despite increases in mitral valve area from 1.05+/-0.16 to 1.74+/-0.4 cm(2) (P<0.0001), accompanied by falls in the transvalvar gradient and pulmonary artery pressure (12.4+/-4.7 to 4.5+/-3 mmHg, and 26.8+/-8.4 to 17.4+/-5.2 mmHg, respectively, all P<0.0001). In conclusion, we found that successful mitral valvuloplasty in our patient cohort led to improved cardiac and physical functional capacity but not resting haemodynamics. Neither indicators of technical success nor resting haemodynamics were very reliable in predicting functional improvement.
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Affiliation(s)
- D J Wright
- Molecular Vascular Medicine, Martin Wing, Leeds General Infirmary, Leeds, UK
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Abstract
The decrease in the incidence of acute rheumatic fever in western countries has led to a sharp decrease in the incidence of mitral stenosis. This decrease also modifies the clinical presentation and mitral stenosis is now encountered in older patients who have severe impairment of valve anatomy. In developing countries, mitral stenosis remains a frequent disease. The management of patients with mitral stenosis has been modified by the development of percutaneous mitral commissurotomy whose safety and efficacy have been demonstrated in a number of studies with a follow-up of up to ten years. Percutaneous mitral commissurotomy is now the reference treatment for mitral stenosis with pliable valves in young patients and its efficacy has been validated in randomised trials versus surgery. Mitral stenosis in older patients, as it is encountered in western countries, is a more heterogeneous group. Predictive analysis has shown that the predictions of immediate and late results are multifactorial. This has led to consider the indications for percutaneous mitral commissurotomy in patients who do not have ideal anatomic conditions, when their other characteristics are favourable. This is particularly the case in young patients who do not have a very tight mitral stenosis (1-1.5 cm2) and who do not have an advanced heart disease. When the conditions are favourable, percutaneous mitral commissurotomy can be considered in patients who have few symptoms, in particular in order to reduce the thromboembolic risk.
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Affiliation(s)
- B Iung
- Service de cardiologie, hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris, France.
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