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Buchwald CLV, Jabri A, Fadel R, Alhuneafat L, Wang DD, Mariscal E, Alqarqaz M, Engel P, O'Neill B, Frisoli T, Lee J, Abbas A, O'Neill WW, Villablanca PA. The various perioperative issues of structural heart diseases and cardiogenic shock. Curr Probl Cardiol 2024; 49:102646. [PMID: 38820919 DOI: 10.1016/j.cpcardiol.2024.102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
Up to 20 % of patients presenting with acute heart failure and cardiogenic shock have a structural etiology. Despite efforts in timely management, mortality rates remain alarmingly high, ranging from 50 % to 80 %. Surgical intervention is often the definitive treatment for structural heart disease; however, many patients are considered high risk or unsuitable candidates for such procedures. Consequently, there has been a paradigm shift towards the development of novel percutaneous management strategies and temporizing interventions. This article aims to provide a comprehensive review of the pathophysiology of valvular and structural heart conditions presenting in cardiogenic shock, focusing on the evolving landscape of mechanical circulatory support devices and other management modalities.
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Affiliation(s)
| | - Ahmad Jabri
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA.
| | - Raef Fadel
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Laith Alhuneafat
- Division of Cardiovascular medicine, University of Minnesota, Minneapolis, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Enrique Mariscal
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Mohammad Alqarqaz
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Pedro Engel
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Brian O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - James Lee
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Amr Abbas
- Division of Cardiovascular Medicine, William Beaumont University Hospital, Royal Oak, MI, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
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Rostambeigi S, Mazaherinia H, Hamidabad NM, Kelsey AM, Alizadehasl A, Harandi STH, Farnoud K, Panahi P, Firouzi A, Sadeghpour A. Impact of commissural calcification on clinical outcome of percutaneous balloon mitral valvuloplasty; a retrospective cohort study of 876 patients. BMC Cardiovasc Disord 2024; 24:309. [PMID: 38890637 PMCID: PMC11184739 DOI: 10.1186/s12872-024-03932-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/09/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Percutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes. METHODS In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9-10, and Group III: score 11-12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC. RESULTS A total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19-2.41, P = 0.003; and OR: 3.90, 95%CI 2.61-5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35-6.27, P = 0.007). CONCLUSION Commissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score ≤ 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV.
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Affiliation(s)
- Saman Rostambeigi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Cardiologist, Tehran, Iran
| | - Homa Mazaherinia
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Cardiologist, Tehran, Iran
| | - Negin Mahmoudi Hamidabad
- School of Medicine, Department of Internal Medicine, Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Anita M Kelsey
- Division of Cardiology and Duke Heart Center, Duke University Medical Center, Durham, NC, England
| | - Azin Alizadehasl
- Cardio-Oncology Department and Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | | | - Khashayar Farnoud
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parsa Panahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Cardiologist, Tehran, Iran
| | - Anita Sadeghpour
- MedStar Cardiovascular Core Lab, MedStar Health Research Institute, Georgetown University, Washington, DC, US.
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Abdelghani M, Nunes MCP, Anwar AM, Prendergast B. Assessment of suitability for percutaneous mitral commissurotomy: a contemporary review of key anatomical criteria and predictive models. Eur Heart J Cardiovasc Imaging 2024; 25:739-753. [PMID: 38376989 DOI: 10.1093/ehjci/jeae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
The immediate result of percutaneous balloon mitral commissurotomy is largely determined by the anatomy of the mitral valve complex. Several scores and models have been developed to assess anatomical suitability for percutaneous balloon mitral commissurotomy. Although none has an optimal predictive power, these models look at the valvular apparatus from different perspectives bearing the potential for a complementary role.
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Affiliation(s)
- Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Cardiology Unit, Sohar Hospital, Muwelleh Street, 311 Sohar, Oman
- Cardiology Department, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maria Carmo P Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ashraf M Anwar
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Bernard Prendergast
- Department of Cardiology, Guys and St Thomas' NHS Foundation Trust Hospital London, London, UK
- Heart, Vascular & Thoracic Institute, Cleveland Clinic London, London, UK
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Ranard LS, Grizzell BE, Vahl TP, Granada JF, Chehab BM. Transfemoral Transcatheter Mitral Valve Implantation With a Dedicated Device in a Rheumatic Mitral Stenosis Patient. JACC Case Rep 2023; 22:101986. [PMID: 37790763 PMCID: PMC10544295 DOI: 10.1016/j.jaccas.2023.101986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 10/05/2023]
Abstract
A 65-year-old obese woman with rheumatic heart disease and restrictive lung disease presented with decompensated heart failure. Evaluation demonstrated severely thickened mitral valve leaflets, severe mitral stenosis, and moderate mitral regurgitation. She underwent successful transfemoral transseptal transcatheter mitral valve replacement with a dedicated valve resulting in improved functional status. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Lauren S. Ranard
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Brett E. Grizzell
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas, USA
| | - Torsten P. Vahl
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Bassem M. Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas, USA
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Weich H, Herbst P, Smit F, Doubell A. Transcatheter heart valve interventions for patients with rheumatic heart disease. Front Cardiovasc Med 2023; 10:1234165. [PMID: 37771665 PMCID: PMC10525355 DOI: 10.3389/fcvm.2023.1234165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Rheumatic heart disease [RHD] is the most prevalent cause of valvular heart disease in the world, outstripping degenerative aortic stenosis numbers fourfold. Despite this, global resources are firmly aimed at improving the management of degenerative disease. Reasons remain complex and include lack of resources, expertise, and overall access to valve interventions in developing nations, where RHD is most prevalent. Is it time to consider less invasive alternatives to conventional valve surgery? Several anatomical and pathological differences exist between degenerative and rheumatic valves, including percutaneous valve landing zones. These are poorly documented and may require dedicated solutions when considering percutaneous intervention. Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for severe mitral stenosis (MS) but is reserved for patients with suitable valve anatomy without significant mitral regurgitation (MR), the commonest lesion in RHD. Valvuloplasty also rarely offers a durable solution for patients with rheumatic aortic stenosis (AS) or aortic regurgitation (AR). MR and AR pose unique challenges to successful transcatheter valve implantation as landing zone calcification, so central in docking transcatheter aortic valves in degenerative AS, is often lacking. Surgery in young RHD patients requires mechanical prostheses for durability but morbidity and mortality from both thrombotic complications and bleeding on Warfarin remains excessively high. Also, redo surgery rates are high for progression of aortic valve disease in patients with prior mitral valve replacement (MVR). Transcatheter treatments may offer a solution to anticoagulation problems and address reoperation in patients with prior MVR or failing ventricles, but would have to be tailored to the rheumatic environment. The high prevalence of MR and AR, lack of calcification and other unique anatomical challenges remain. Improvements in tissue durability, the development of novel synthetic valve leaflet materials, dedicated delivery systems and docking stations or anchoring systems to securely land the transcatheter devices, would all require attention. We review the epidemiology of RHD and discuss anatomical differences between rheumatic valves and other pathologies with a view to transcatheter solutions. The shortcomings of current RHD management, including current transcatheter treatments, will be discussed and finally we look at future developments in the field.
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Affiliation(s)
- Hellmuth Weich
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip Herbst
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Francis Smit
- Robert W.M. Frater Cardiovascular Research Centre, University of the Free State, Bloemfontein, South Africa
| | - Anton Doubell
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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7
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Current status of adult cardiac surgery-Part 1. Curr Probl Surg 2022; 59:101246. [PMID: 36496252 DOI: 10.1016/j.cpsurg.2022.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Yadav S, Shah S, Gajurel RM, Poudel CM, Ghimire R, Shah N. A study of Clinical Profile and in Hospital Outcomes of patients undergoing Percutaneous Transvenous Mitral Commissurotomy at a Tertiary Care Center of Nepal. Ann Med Surg (Lond) 2022; 84:104867. [PMID: 36536708 PMCID: PMC9758362 DOI: 10.1016/j.amsu.2022.104867] [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: 07/30/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Rheumatic heart disease (RHD), is a common cause of mitral stenosis (MS) in developing nations. As per current recommendation, Percutaneous Transvenous Mitral Commissurotomy (PTMC) is advised as a Class IA (I-Class Of Recommendation, COR; A-Level Of Evidence, LOE) indication in patients with symptomatic severe mitral stenosis. We aim to examine the clinical profile and in-hospital results of PTMC for mitral stenosis. Methods A cross-sectional retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center from April 2020 to May 2022. A structured questionnaire was used to collect the data and ethical approval for conducting the study was taken from the Institutional Review Committee (IRC) of Institute of Medicine (IOM). The data was collected in Microsoft Excel (Ver. 2013). For statistical analysis, SPSS 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Association was measured using a parametric and non-parametric test (depending upon the distribution of data) and p value < 0.05 was considered significant. Results A total of 104 patients who met the inclusion criteria underwent PTMC during the study period. The mean age group of the patient was 41.7 ± 12.5 years, of which 23 (22.1%) were males and 81 (78.9%) were females. Mean mitral valve area prior to PTMC was 0.98 ± 0.19 mm2 that increased to 1.69 ± 0.19 mm2 after the procedure and it was statistically significant (p=<0.001). The post PTMC MVA varied with PTMC Wilkin's score with less than or equal to 8 having favorable outcomes. Conclusion Successful PTMC is highly influenced by the patients' increasing age, valve morphology (calcification, thickness, mobility), Left atrial dimensions, Pre PTMC mitral valve area, Degree of Baseline mitral regurgitation. Post procedure development of MR is usually well tolerated but rarely be severe enough requiring surgical valve replacement.
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Key Words
- AF, atrial fibrillation
- BMV, balloon mitral valvotomy
- CMC, closed mitral commissurotomy
- LA, left atrium
- LAP, left atrial pressure
- LVEF, Left ventricular ejection fraction
- LVSD, Left ventricle systolic dysfunction
- MI, Myocardial Infarction
- MS, mitral stenosis
- MVA, mitral valve area
- MVR, mitral valve replacement
- Mitral regurgitation
- Mitral stenosis
- Mitral valve area
- NSR, normal sinus rhythm
- NYHA, New York Heart Association
- Nepal
- OMC, open mitral commissurotomy
- Outcomes
- PA, pulmonary artery
- PASP, pulmonary artery systolic pressure
- PTMC
- PTMC, percutaneous transvenous mitral commissurotomy
- RHD, rheumatic heart disease
- TTE TEE, Transthoracic Echocardiography Transesophageal Echo
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Affiliation(s)
- Sutap Yadav
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Sangam Shah
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Ratna Mani Gajurel
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Chandra Mani Poudel
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Roshan Ghimire
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Nischal Shah
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
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Turi ZG. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100087. [PMID: 37288059 PMCID: PMC10242581 DOI: 10.1016/j.shj.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/09/2023]
Abstract
Percutaneous balloon mitral valvuloplasty (PBMV), once the most complex of percutaneous cardiac procedures and essentially the first adult structural heart intervention, set the stage for a host of new technologies. Randomized studies comparing PBMV to surgery were the first to provide a high-level evidence base in structural heart. The devices used have changed little in 40 years, but the advent of improved imaging and the expertise gained in interventional cardiology has provided some additional procedural safety. However, with the decline in rheumatic heart disease, PBMV is being performed in fewer patients in industrialized nations; in turn, these patients have more comorbidities, less favorable anatomy, and thus a higher rate of procedure-related complications. There remain relatively few experienced operators, and the procedure is distinct enough from the rest of the structural heart intervention world that it has its own steep learning curve. This article reviews the use of PBMV in a variety of clinical settings, the influence of anatomic and physiologic factors on outcomes, the changes in the guidelines, and alternative approaches. PBMV remains the procedure of choice in patients with mitral stenosis with ideal anatomy and a useful tool in patients with less than ideal anatomy who are poor surgical candidates. In the 40 years since its first performance, PBMV has revolutionized the care of mitral stenosis patients in developing countries and remains an important option for suitable patients in industrialized nations.
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Affiliation(s)
- Zoltan G. Turi
- Address correspondence to: Zoltan G. Turi, MD, Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ 07601.
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Chan N, Orchard J, Agbayani M, Boddington D, Chao T, Johar S, John B, Joung B, Krishinan S, Krittayaphong R, Kurokawa S, Lau C, Lim TW, Linh PT, Long VH, Naik A, Okumura Y, Sasano T, Yan B, Raharjo SB, Hanafy DA, Yuniadi Y, Nwe N, Awan ZA, Huang H, Freedman B. 2021 Asia Pacific Heart Rhythm Society (APHRS) practice guidance on atrial fibrillation screening. J Arrhythm 2021; 38:31-49. [PMID: 35222749 PMCID: PMC8851593 DOI: 10.1002/joa3.12669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ngai‐Yin Chan
- Princess Margaret Hospital Hong Kong Special Administrative Region China
| | - Jessica Orchard
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute Sydney Australia
- Charles Perkins Centre The University of Sydney Sydney Australia
| | - Michael‐Joseph Agbayani
- Division of Electrophysiology Philippine Heart Center Manila Philippines
- Division of Cardiovascular Medicine Philippine General Hospital Manila Philippines
| | - Dean Boddington
- Cardiology Department Tauranga Hospital Tauranga New Zealand
| | - Tze‐Fan Chao
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center National Yang Ming Chiao Tung University Taipei Taiwan
| | - Sofian Johar
- Consultant Cardiologist Head of Cardiology RIPAS Hospital Bandar Seri Begawan Brunei Darussalam
- Consultant Cardiac Electrophysiologist Head of Cardiac Electrophysiology Gleneagles JPMC Jerudong Brunei Darussalam
- Institute of Health SciencesUniversiti Brunei Darussalam Jalan Tungku Link Gadong Brunei Darussalam
| | - Bobby John
- Cardiology UnitTownsville University Hospital Townsville Australia
- James Cook University Townsville Australia
| | - Boyoung Joung
- Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | | | - Rungroj Krittayaphong
- Division of Cardiology Department of Medicine Siriraj HospitalMahidol University Bangkok Thailand
| | - Sayaka Kurokawa
- Division of Cardiology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Chu‐Pak Lau
- Department of Medicine Queen Mary HospitalThe University of Hong Kong Hong Kong Special Administrative Region China
| | - Toon Wei Lim
- National University HospitalNational University Heart Centre Singapore
| | | | | | - Ajay Naik
- Division of Cardiology Care Institute of Medical Sciences Hospital Ahmedabad India
| | - Yasuo Okumura
- Division of Cardiology Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Bernard Yan
- Melbourne Brain Centre University of Melbourne Melbourne Australia
| | - Sunu Budhi Raharjo
- Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Dicky Armein Hanafy
- Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Nwe Nwe
- Department of Cardiology Yangon General HospitalUniversity of Medicine Yangon Myanmar
| | | | - He Huang
- Wuhan University Renmin Hospital Wuhan China
| | - Ben Freedman
- Charles Perkins Centre The University of Sydney Sydney Australia
- Heart Research Institute Charles Perkins Centre University of Sydney Sydney Australia
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Momen A, Ali MZ, Hyder Chowdhury NA, Huda RM, Nobi AN, Rahman AU, Alam I, Sayami LA, Alam MA, Hossain MD, Tasneem S. Difficulties to enter the left ventricle during percutaneous transvenous mitral commissurotomy (PTMC)- our experiences of 80 cases with modified techniques. Indian Heart J 2021; 73:612-616. [PMID: 34627578 PMCID: PMC8514396 DOI: 10.1016/j.ihj.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background Percutaneous transvenous mitral commissurotomy (PTMC) is the standard of treatment for symptomatic severe rheumatic mitral stenosis (MS). PTMC has the standard Inoue technique, but we have to modify the procedure in many technically challenging cases, especially to cross the mitral valve. Methodology Two over-the-wire strategies to enter the LV were taken in 80 complex cases of PTMC. The first one was done by exchanging the J-shaped wire from the balloon, introducing the spring wire into it, and pushing it into LV. The second one-removal of balloon keeping the spring wire in LA and the Mullin's sheath was introduced, and the tip of the wire was pushed into LV, and the balloon was introduced over the wire. We also changed the left atrium (LA) graphy in the RAO view instead of the AP view to facilitating entry into LV. Results We succeeded in 76 (95 %) cases. Strategy one was applied to all but successful in only 25 cases (31 %), and strategy 2 was applied in the remaining. Strategy 1 required less procedural time and fluoroscopic time in comparison to strategy 2 (40 ± 10 vs 60 ± 16 min, 25 ± 7 vs 35 ± 8 min). After modification of taking the LA graphy in RAO view, our rate of facing the difficulties decreased from 21 % to 9 %. Critical MS (31 %) and the giant LA (30 %) were the topmost causes of difficulties. No major complications were recorded. Conclusion Over-the-wire entry into LV is cost-effective, requiring no new equipment and is safe and can be used in complex cases.
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Affiliation(s)
- Abdul Momen
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
| | - Md Zulfikar Ali
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | | | - Reaz Mahmud Huda
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Abm Nurun Nobi
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Ashraf Ur Rahman
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Iftequar Alam
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | | | - Md Abul Alam
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | | | - Samia Tasneem
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
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12
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Usta E, Erdim R, Görmez S, Dogan A, Ezelsoy M, Kahraman S, Bayram M, Yazicioğlu N. Comparison of early and long-term follow-up results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. ACTA ACUST UNITED AC 2021; 67:58-63. [PMID: 34161466 DOI: 10.1590/1806-9282.67.01.20200277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Percutaneous mitral balloon valvuloplasty and mitral valve replacement have been the treatment options for mitral stenosis for several years, however, studies that compare these two modalities are very rare in the literature. OBJECTIVE In this article, we aim to investigate the comparison of clinical results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. METHODS 527 patients with rheumatic mitral stenosis, treated with percutaneous mitral balloon valvuloplasty or mitral valve replacement (276 patients with percutaneous mitral balloon valvuloplasty and 251 patients with mitral valve replacement) from 1991 to 2012 were evaluated. The demographic characteristics, clinical, echocardiographic and catheterization data of patients were evaluated retrospectively. The results of early and late clinical follow-up of patients after percutaneous mitral balloon valvuloplasty and mitral valve replacement were also evaluated. RESULTS The mean follow-up time of the percutaneous mitral balloon valvuloplasty group was 4.7 years and, for the mitral valve replacement-group, it was 5.45 years. The hospital stay of the percutaneous mitral balloon valvuloplasty group was shorter than that of the mitral valve replacement group (2.02 days vs 10.62 days, p<0.001). The hospital mortality rate of percutaneous mitral balloon valvuloplasty and mitral valve replacement were 0% and 2% respectively (p=0.024). In the percutaneous mitral balloon valvuloplasty group, early postprocedural success rate was 92.1%. The event-free survival of percutaneous mitral balloon valvuloplasty and mitral valve replacement was found to be similar. While reintervention was higher in percutaneous mitral balloon valvuloplasty-group (p<0.001), mortality rate was higher in mitral valve replacement-group (p<0.001). CONCLUSION Percutaneous mitral balloon valvuloplasty seems to be more advantageous than mitral valve replacement due to low mortality rates, easy application of the procedure and no need for general anesthesia.
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Affiliation(s)
- Emrah Usta
- Istanbul Bilim University, Faculty of Medicine, Department of Cardiology - Istanbul, Turkey
| | - Refik Erdim
- Acıbadem Mehmet Ali Aydınlar University, Kadıkoy Hospital, Clinic of Cardiology - Istanbul, Turkey
| | - Selçuk Görmez
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Medicine, Department of Cardiology - Istanbul, Turkey
| | - Ali Dogan
- Istanbul Bilim University, Faculty of Medicine, Department of Cardiology - Istanbul, Turkey
| | - Mehmet Ezelsoy
- Istanbul Bilim University, Faculty of Medicine, Department of Cardiovascular Surgery - Istanbul, Turkey
| | - Serkan Kahraman
- Istanbul Bilim University, Faculty of Medicine, Department of Cardiology - Istanbul, Turkey
| | - Muhammed Bayram
- Istanbul Bilim University, Faculty of Medicine, Department of Cardiovascular Surgery - Istanbul, Turkey
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13
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Abu Rmilah AA, Tahboub MA, Alkurashi AK, Jaber SA, Yagmour AH, Al-Souri D, Lewis BR, Nkomo VT, Erwin PJ, Reeder GS. Efficacy and safety of percutaneous mitral balloon valvotomy in patients with mitral stenosis: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2021; 33:100765. [PMID: 33889711 PMCID: PMC8050729 DOI: 10.1016/j.ijcha.2021.100765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 12/01/2022]
Abstract
Aims Percutaneous mitral balloon valvotomy PMBV is an acceptable alternative to Mitral valve surgery for patients with mitral stenosis. The purpose of this study was to explore the immediate results of PMBV with respect to echocardiographic changes, outcomes, and complications, using a meta-analysis approach. Methods MEDLINE, and EMBASE databases were searched (01/2012 to 10/2018) for original research articles regarding the efficacy and safety of PMBV. Two reviewers independently screened references for inclusion and abstracted data including article details and echocardiographic parameters before and 24–72 h after PMBV, follow-up duration, and acute complications. Disagreements were resolved by third adjudicator. Quality of all included studies was evaluated using the Newcastle-Ottawa Scale NOS. Results 44/990 references met the inclusion criteria representing 6537 patients. Our findings suggest that PMBV leads to a significant increase in MVA (MD = 0.81 cm2; 0.76–0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52–3.26, p = 0.007), LVEDV EDV (MD = 5.81 ml; 2.65–8.97, p = 0.0003) and decrease in MPG (MD = −7.96 mmHg; −8.73 to −7.20, p < 0.00001), LAP (MD = −10.09 mmHg; −11.06 to −9.12, p < 0.00001), and SPAP (MD = −15.55 mmHg; −17.92 to −13.18, p < 0.00001). On short term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7%% respectively. On long term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7% respectively Conclusion PMBV represents a successful approach for patients with mitral stenosis as evidenced by improvement in echocardiographic parameters and low rate of complications.
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Key Words
- AF, Atrial fibrillation
- AHA/ACC, American Heart Association (AHA) and American College of Cardiology (ACC)
- Echocardiography
- LAD, Left atrial diameter
- LAP, Left atrial pressure
- LV EDP, Left ventricle end-diastolic pressure
- LV EDV, Left ventricle end-diastolic volume
- LV ESP, Left ventricle end-systolic pressure
- LV ESV, Left ventricle end-systolic volume
- MACCE, Major adverse cardiovascular and cerebrovascular events
- MD, Mean difference
- MPG, Mitral pressure gradient
- MR, Mitral regurgitation
- MS, Mitral stenosis
- MVA, Mitral valve area
- Mitral stenosis
- Mitral valve surgery
- NOS, New castle Ottawa scale
- PMBV, percutaneous mitral balloon valvotomy
- Percutaneous balloon mitral valvotomy
- Percutaneous balloon mitral valvuloplasty
- SR, sinus rhythm
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Affiliation(s)
- Anan A Abu Rmilah
- William J. von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mahmoud A Tahboub
- William J. von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, MN, USA
| | - Adham K Alkurashi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suhaib A Jaber
- Department of Internal Medicine, Al Hamadi Hospital, Riyadh, Saudi Arabia
| | | | - Deema Al-Souri
- Department of Internal Medicine, Med Star Washington Hospital Center, Washington DC, USA
| | - Bradley R Lewis
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Nikolou E, Bilkhu R, Kafil TS, Demetrescu C, Kotta PA, Lucchese G, Tzemos N, Grapsa J. Multimodality Imaging in Transcatheter Mitral Interventions. Front Cardiovasc Med 2021; 8:638399. [PMID: 33718458 PMCID: PMC7950542 DOI: 10.3389/fcvm.2021.638399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/29/2021] [Indexed: 11/21/2022] Open
Abstract
Multimodality imaging is of imperative value for the planning and guidance of transcatheter mitral valve interventions. This review employs the value of different imaging modalities and future implications for clinical practice.
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Affiliation(s)
- Evgenia Nikolou
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rajdeep Bilkhu
- Department of Cardiothoracic Surgery, Guys and St Thomas NHS Hospitals Trust, London, United Kingdom
| | - Tahir S. Kafil
- Department of Cardiology, Western University, London, ON, Canada
| | - Camelia Demetrescu
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, United Kingdom
| | - Prasanti Alekhya Kotta
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, United Kingdom
| | - Gianluca Lucchese
- Department of Cardiothoracic Surgery, Guys and St Thomas NHS Hospitals Trust, London, United Kingdom
| | - Nikolaos Tzemos
- Department of Cardiology, Western University, London, ON, Canada
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, United Kingdom
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 517] [Impact Index Per Article: 172.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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17
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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18
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 320] [Impact Index Per Article: 106.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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19
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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Abstract
Rheumatic heart disease results in significant remodeling of the atria that provides the milieu for maintaining atrial fibrillation. Some electrical remodeling is reversible and hence early intervention may prove useful. Active screening for atrial fibrillation in high-risk subset and instituting anticoagulation may reduce the devastating complications that follow. Age older than 50 years, NYHA functional class II symptoms, left atrial dimension >4.0 cm on echocardiogram in parasternal long-axis view, and gradients across the mitral valve >10 mm Hg are clinical indicators that identify the high-risk subset. Ablation strategy in this population may differ compared with the nonvalvular group.
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Affiliation(s)
- Bobby John
- James Cook University, Townsville, Australia; Cardiology Unit, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia; Christian Medical College, Vellore, India.
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Suite 1301-3, Central Building, 1 Pedder Street, Central, Hong Kong
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21
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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: 20] [Impact Index Per Article: 5.0] [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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22
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Kubota N, Ozaki K, Hoyano M, Nishida K, Takano T, Okubo T, Kimura S, Yanagawa T, Kashimura T, Minamino T. Long-Term Prognosis of Patients Who Underwent Percutaneous Transvenous Mitral Commissurotomy for Mitral Stenosis. Int Heart J 2020; 61:1183-1187. [PMID: 33191340 DOI: 10.1536/ihj.20-082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The long-term prognosis for up to 20 years of patients who have undergone percutaneous transvenous mitral commissurotomy (PTMC) for mitral stenosis (MS) is unknown.We examined 77 of 93 patients (83%) with MS and who underwent PTMC from 1989 to 2002 at our institute, as well as the occurrence of either one of the following clinical endpoints until September 1, 2018: all-cause death or repeat intervention for the mitral valve.The mean follow-up duration was 20.5 ± 7.3 years. The mean age was 51 ± 11 years. Overall, the 20-year survival rate was 71% ± 5%; without any intervention, the 20-year survival rate was 40% ± 6%. In patients who achieved good immediate results (i.e., mitral valve area (MVA) of ≥ 1.5 cm2 without mitral regurgitation (MR) of > 2/4 after PTMC), the 20-year survival rate was 80% ± 6%; without any intervention, the 20-year survival rate was 54% ± 7%.In our 20-year observational study, patients who have undergone PTMC for MS had favorable prognosis, especially in those who achieved good immediate results. In those who had poor immediate results, careful follow-up is needed because they might have more clinical event and any intervention for the mitral valve.
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Affiliation(s)
- Naoki Kubota
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Makoto Hoyano
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kota Nishida
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Toshiki Takano
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takeshi Okubo
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Shinpei Kimura
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takao Yanagawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takeshi Kashimura
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences
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Han J, Tian B, Wu F, Jiao Y, Pang S, Xu J, Meng X. Surgical rheumatic mitral valve repair compared with percutaneous balloon mitral valvuloplasty in mitral stenosis in current era: a propensity score matching study. J Thorac Dis 2020; 12:6752-6760. [PMID: 33282376 PMCID: PMC7711429 DOI: 10.21037/jtd-20-1694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Many comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with “four-step” procedure in the treatment of rheumatic MS. Methods Patients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences. Results A total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP. Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm2, P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively. Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent re-intervention in rMVP, but one patient died of pneumonia. Conclusions For selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with “four-step” procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).
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Affiliation(s)
- Jie Han
- Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Baiyu Tian
- Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Fang Wu
- Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yuqing Jiao
- Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Shuai Pang
- Center of Cardiovascular Surgery, the People's Hospital of Huaiyin Jinan, Jinan, China
| | - Jinguo Xu
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Meng
- Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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24
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Interventional Cardiology and Catheter-Based Interventions in Pregnancy. Cardiol Rev 2020; 30:24-30. [PMID: 33027066 DOI: 10.1097/crd.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease is the leading cause of maternal mortality worldwide and has been increasing in prevalence over the last several decades. Pregnancy is associated with significant hemodynamic changes that can overwhelm the maternal cardiovascular reserve, and may exacerbate previously asymptomatic cardiovascular disease. Complications associated with these may cause substantial harm to both the mother and the fetus, and the management of these conditions is often challenging. Numerous novel treatments and interventions have demonstrated the safety and efficacy of managing these conditions outside of pregnancy. However, there are little data regarding their use in the pregnant population. In this review, we describe the common cardiovascular diseases encountered during pregnancy and discuss their management strategies, with a particular focus on the role of percutaneous, catheter-based therapeutic interventions.
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Peters F, Karthikeyan G, Abrams J, Muhwava L, Zühlke L. Rheumatic heart disease: current status of diagnosis and therapy. Cardiovasc Diagn Ther 2020; 10:305-315. [PMID: 32420113 DOI: 10.21037/cdt.2019.10.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Rheumatic heart disease (RHD) is the only preventable cardiovascular disease which causes significant morbidity and mortality particularly in low- and middle-income countries. Early clinical diagnosis is key, the updated Jones criteria increases the likelihood of diagnosis in endemic settings, including the echo diagnosis of sub-clinical carditis, polyarthralgia and monoarthritis as well as amended thresholds of minor criteria. The mainstay of rheumatic heart valve disease (RHVD) is a thorough clinical and echocardiographic investigation while severe disease is managed with medical, interventional and surgical treatment. In this report we detail some of the more recent epidemiological findings and focus on the diagnostic and interventional elements of the specific valve lesions. Finally, we discuss some of the recent efforts to improve medical and surgical management for this disease. As we are already more than a year from the historic 2018 World Heart Organization Resolution against Rheumatic Fever and Rheumatic Heart Disease, we advocate strongly for renewed efforts to prioritize this disease across the endemic regions of the world.
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Affiliation(s)
- Ferande Peters
- Cardiovascular pathophysiology and Genomic Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ganesan Karthikeyan
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jessica Abrams
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Lorrein Muhwava
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Abstract
Mitral stenosis (MS) is a progressive and devastating disease and most often occurs among young women. Given its considerable prevalence in Mediterranean and Eastern European countries according to the Euro Heart Survey, new imaging modalities are warranted to improve the management of patients with this condition. A wide spectrum of abnormalities occurs involving all parts of this complex structure and causing different grades of MS and/or regurgitation as a consequence of rheumatic affection. Novel imaging modalities significantly improved the assessment of several aspects of this rheumatic destructive process including the morphological alterations of the mitral valve (MV) apparatus, left atrial (LA) function, LA appendage, right and left ventricular (LV) functions, and complications, namely, atrial fibrillation and thromboembolic events. Furthermore, new imaging modalities improved the prediction of outcome of patients who underwent percutaneous balloon mitral comissurotomy and changed the paradigm of patient selection for intervention and risk stratification. The present review aimed to summarize the role of new multimodality, multiparametric imaging approaches to assess the morphological characteristics of the rheumatic MS and its associated complications, and to guide patient management.
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Mitral valve calcium assessment: An independent predictor of balloon valvuloplasty results. Indian Heart J 2019; 71:454-458. [PMID: 32248917 PMCID: PMC7136341 DOI: 10.1016/j.ihj.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/01/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Shojaeifard M, Samiei N, Firouzi A, Sanati HR, Mohebbi B, Ghadrdoost B, Erami S, Farrashi M. Rapid improvement in right ventricular free wall longitudinal strain measures after successful percutaneous mitral commissurotomy. Echocardiography 2019; 36:1846-1851. [PMID: 31573722 DOI: 10.1111/echo.14491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/22/2019] [Accepted: 09/07/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Percutaneous mitral commissurotomy (PMC) is currently the treatment of choice for patients with symptomatic mitral stenosis (MS) that have favorable valvular characteristics. We aimed to evaluate the effect of PMC on the longitudinal strain of the right ventricular (RV) free wall in patients with severe MS. METHODS This prospective study recruited patients who underwent PMC. Transesophageal and transthoracic echocardiographic examinations were performed. The mitral valve area (MVA) was measured by three-dimensional evaluation. The RV longitudinal strain was measured via the speckle-tracking method. RESULTS A total of 42 patients with a maximum MVA of 1.5 cm2 underwent PMC in our study. The MVA increased significantly after the procedure (pre-PMC MVA = 0.94 ± 0.20 cm2 vs post-PMC MVA = 1.45 ± 0.18 cm2 ; P < .01). Systolic pulmonary artery pressure decreased from 46.05 ± 14.08 mm Hg preprocedurally to 35.86 ± 7.53 mm Hg postprocedurally (P < .01). The mean RV free wall longitudinal strain was -19.00 ± 5.14%, which rose significantly after PMC to -20.97 ± 3.81 (P < .05). There were postprocedural increases, albeit nonsignificant, in the tricuspid annular peak systolic excursion, the peak systolic Doppler velocity of the RV free wall, and fractional area change. The improvement in the RV longitudinal strain was more prominent in the patients with an MVA of less than 1.0 cm2 . CONCLUSIONS There was a significant post-PMC rise in the RV free wall longitudinal strain measures in our study population, demonstrating an immediate improvement in the RV systolic function of the patients.
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Affiliation(s)
- Maryam Shojaeifard
- Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Sanati
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajad Erami
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Melody Farrashi
- Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
See Article Desnos et al
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Affiliation(s)
- Igor F Palacios
- 1 Massachusetts General Hospital Boston MA.,2 Harvard Medical School Boston MA
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Desnos C, Iung B, Himbert D, Ducrocq G, Urena M, Cormier B, Brochet E, Ou P, Vahanian A, Bouleti C. Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience. J Am Heart Assoc 2019; 8:e012031. [PMID: 31256703 PMCID: PMC6662374 DOI: 10.1161/jaha.119.012031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Percutaneous mitral commissurotomy (PMC) was the first available transcatheter technique for treatment of mitral valve diseases. Experience has led to extending the indications to patients with less favorable characteristics. We aimed to analyze (1) the temporal trends in characteristic and outcomes of patients undergoing PMC in a single center over 30 years and (2) the predictive factors of poor immediate results of PMC. Methods and Results From 1987 to 2016, 1 full year for each decade was analyzed: 1987, 1996, 2006, and 2016. Poor immediate results of PMC were defined as a mitral valve area <1.5 cm2 or MR (mitral regurgitation) grade >2. Mitral anatomy was assessed using the Cormier classification and the fluoroscopic extent of calcification. Six hundred three patients were included: 111, 202, 205, and 85, respectively. Mean age increased >10 years over time (P<0.0001). Mitral anatomy was less favorable over the years: the presence of calcification increased from 25% of patients at the beginning of PMC to >40% during the past decade (P<0.0001) with a 3‐fold increase in severe mitral calcification. Consistently, the proportion of good immediate results decreased over time (P<0.05) but remained at 76% in 2016. Multivariate analysis showed 3 predictive factors of poor immediate results: smaller baseline mitral valve area (P<0.0001), pre‐PMC MR grade 2 (P<0.01), and the presence or amount of calcification (P<0.001). Conclusions This clinic's patients became significantly older with more frequent and severe calcification in the past decade. Predictive factors of poor immediate results were related to valve anatomy, including calcification. Despite challenges raised by severe calcification, PMC was still successful in >3 out of 4 patients in recent years. See Editorial Palacios
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Affiliation(s)
- Cyrielle Desnos
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France
| | - Bernard Iung
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Dominique Himbert
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Grégory Ducrocq
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Marina Urena
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | | | - Eric Brochet
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France
| | - Phalla Ou
- 2 Department of Radiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Alec Vahanian
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Claire Bouleti
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
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Abstract
PURPOSE OF REVIEW This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS). RECENT FINDINGS While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented. For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.
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Immediate and late clinical outcomes of balloon mitral valvotomy based on immediate postballoon mitral valvotomy mitral valve area & percentage gain in mitral valve area-A tertiary centre study. Indian Heart J 2019; 70 Suppl 3:S338-S346. [PMID: 30595286 PMCID: PMC6309712 DOI: 10.1016/j.ihj.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/16/2018] [Accepted: 09/20/2018] [Indexed: 12/30/2022] Open
Abstract
AIM The aim of the study was to compare the immediate and late clinical outcomes of balloon mitral valvotomy (BMV), based on the immediate post-BMV valve area and percentage gain in mitral valve area (MVA). METHODS Clinical data of 818 consecutive patients who underwent BMV in our institute from 2000 to 2008 were analyzed retrospectively. They were categorized into three groups based on the postprocedural MVA and percentage gain in valve area-(1) 50% gain with final MVA <1.5 cm2, group 1 (fair result); (2) final MVA of ≥1.5 cm2, group 2 (good result); and (3) <50% gain with final MVA <1.5 cm2, group 3 (suboptimal result). RESULTS The baseline characteristics of the three patient groups were clearly distinct. Those who had <50% gain with final MVA <1.5 cm2 were older and had higher incidence of atrial fibrillation (17 [22.4%]), heart failure (32 [42.1%]), pulmonary artery hypertension (45 [59.2%]), and significantly deformed valves (39 [51.3%]) at baseline. At a mean follow-up period of 5.64 ± 3.84 years, incidence of redo BMV (23 [4.6%]) and mitral valve replacement (17 [3.4%]) was higher in them than those with immediate MVA ≥1.5 cm2. Among those with MVA <1.5 cm2, events on follow-up were similar irrespective of the percentage gain in MVA. CONCLUSIONS Immediate postprocedural MVA of ≥1.5 cm2, and not percentage gain, predicts better long-term clinical outcomes after BMV. Patients who had less than 50% gain with final MVA <1.5 cm2 represent high-risk population with advanced mitral valve disease and comorbidities.
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Turi ZG. The “Very” Long and Short of It. JACC Cardiovasc Interv 2018; 11:1953-1955. [DOI: 10.1016/j.jcin.2018.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022]
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Rheumatic Heart Disease Worldwide. J Am Coll Cardiol 2018; 72:1397-1416. [DOI: 10.1016/j.jacc.2018.06.063] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022]
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Meneguz-Moreno RA, Costa JR, Gomes NL, Braga SLN, Ramos AIO, Meneghelo Z, Maldonado M, Ferreira-Neto AN, Franca JID, Siqueira D, Esteves C, Sousa A, Sousa JE, Abizaid A. Very Long Term Follow-Up After Percutaneous Balloon Mitral Valvuloplasty. JACC Cardiovasc Interv 2018; 11:1945-1952. [PMID: 30077684 DOI: 10.1016/j.jcin.2018.05.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess very long term outcomes after successful percutaneous balloon mitral valvuloplasty (PBMV). BACKGROUND PBMV remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis and suitable anatomy. METHODS All consecutive patients who underwent successful PBMV between 1987 and 2010 were included. The primary endpoint was the composite of all-cause mortality, need for mitral surgery, or repeat PBMV up to 23 years. RESULTS Among all 1,582 consecutive patients undergoing PBMV, acute success was achieved in 90.9% (n = 1,438). Independent predictors of acute success included left atrial size (odds ratio: 0.96; 95% confidence interval [CI]: 0.93 to 0.99; p = 0.045), Wilkins score ≤8 (odds ratio: 1.66; 95% CI: 0.48 to 0.93; p = 0.02) and age (odds ratio: 0.97; 95% CI: 0.96 to 0.99; p = 0.006). Very long term follow-up (median 8.3 years, mean 15.6 years) was obtained in 79.1% of successful cases. The incidence of the primary endpoint was 19.1% (95% CI: 17.0% to 21.1%). The rates of overall mortality, need for mitral valve surgery, or repeat PBMV were 0.6% (95% CI: 0.3% to 1.2%), 8.3% (95% CI: 7.0% to 9.9%), and 10.0% (95% CI: 8.5% to 11.7%), respectively. On multivariate analysis, New York Heart Association functional class III or IV (hazard ratio: 1.62; 95% CI: 1.26 to 2.09; p < 0.001), higher age (hazard ratio: 0.97; 95% CI: 0.96 to 0.98; p = 0.028), and mitral valve area ≤1.75 cm2 after the procedure (hazard ratio: 1.67; 95% CI: 1.28 to 2.11; p = 0.028) were independent predictors of the primary endpoint. CONCLUSIONS In very long term follow-up, more than 75% of patients exhibited sustained results. Prediction of late favorable results is multifactorial and strongly determined by age, previous symptoms and post-procedural mitral valve area.
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Affiliation(s)
- Rafael A Meneguz-Moreno
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil; Department of Medicine, Universidade Federal de Sergipe, Sergipe, Brazil.
| | - J Ribamar Costa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Nisia L Gomes
- Department of Structural Heart Disease, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Sergio L N Braga
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Auristela I O Ramos
- Department of Structural Heart Disease, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Zilda Meneghelo
- Department of Structural Heart Disease, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Mercedes Maldonado
- Department of Echocardiography, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Alfredo N Ferreira-Neto
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - J Italo D Franca
- Department of Biostatistics, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Dimytri Siqueira
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Cesar Esteves
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Amanda Sousa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - J Eduardo Sousa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
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Passeri JJ, Dal-Bianco JP. Percutaneous Balloon Mitral Valvuloplasty: Echocardiographic Eligibility and Procedural Guidance. Interv Cardiol Clin 2018; 7:405-413. [PMID: 29983151 DOI: 10.1016/j.iccl.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rheumatic mitral stenosis remains a common disease in the developing world. Percutaneous mitral balloon valvuloplasty is an important therapy for rheumatic mitral stenosis. Echocardiography plays a critical role in the diagnosis of rheumatic mitral stenosis and the assessment of suitability for and guidance of percutaneous mitral valvuloplasty.
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Affiliation(s)
- Jonathan J Passeri
- Heart Valve Program, Corrigan Minehan Heart Center, Massachusetts General Hospital, Yawkey Building Suite 5B, 55 Fruit Street, Boston, MA 02114, USA.
| | - Jacob P Dal-Bianco
- Heart Valve Program, Corrigan Minehan Heart Center, Massachusetts General Hospital, Yawkey Building Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
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Wunderlich NC, Beigel R, Ho SY, Nietlispach F, Cheng R, Agricola E, Siegel RJ. Imaging for Mitral Interventions. JACC Cardiovasc Imaging 2018; 11:872-901. [DOI: 10.1016/j.jcmg.2018.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/12/2018] [Accepted: 02/22/2018] [Indexed: 10/14/2022]
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Cho IJ, Kim SJ, Han D, Kim D, Shim CY, Hong GR, Chang HJ. Different Characteristics, Clinical Outcomes, and Left Atrial Reverse Remodeling in Patients with Mitral Stenosis Maintaining Sinus Rhythm for at Least 10 Years after Successful Percutaneous Mitral Valvuloplasty. Cardiology 2018; 140:14-20. [PMID: 29649813 DOI: 10.1159/000486708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to investigate the characteristics and echocardiographic changes in patients with severe mitral stenosis (MS) who maintained sinus rhythm (SR) for at least 10 years after successful percutaneous mitral balloon valvuloplasty (PMV). METHODS We retrospectively reviewed 107 patients who had successful PMV and follow-up echocardiography for at least 10 years without mitral valve surgery. Preprocedural, immediate postprocedural (PMV), and long-term follow-up echocardiography (at least 10 years after PMV) data were reviewed. RESULTS The mean follow-up time after PMV was 15 ± 4 years for SR patients (n = 50) and 16 ± 4 years (p = 0.172) for atrial fibrillation (AF) patients (n = 57). The left atrial diameter was significantly decreased in SR patients in the follow-up echocardiography images compared to its pre-PMV value (46.7 ± 6.3 vs. 43.3 ± 6.2 mm, respectively), whereas it was significantly increased in patients with AF (53.9 ± 7.1 vs. 58.1 ± 8.7 mm). In multivariate analysis, preprocedural AF (odds ratio [OR] 14.50, p = 0.001) and LA diameter ≥50 mm (OR 8.81, p < 0.001) were independently associated with increased risk for the presence of AF after successful PMV. CONCLUSION Very long-term maintenance of SR after successful PMV was associated with preprocedural SR and LA diameter < 50 mm.
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Affiliation(s)
- In-Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo-Jin Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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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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Iung B, Leenhardt A, Extramiana F. Management of atrial fibrillation in patients with rheumatic mitral stenosis. Heart 2018; 104:1062-1068. [DOI: 10.1136/heartjnl-2017-311425] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 01/03/2023] Open
Abstract
Atrial fibrillation (AF) is frequent in patients with rheumatic mitral stenosis (MS). Pressure overload leads to marked structural and electrical remodelling of left atrium. The frequency of persistent AF increases with age and paroxysmal, asymptomatic, AF seems even more frequent. The occurrence of AF worsens the haemodynamic tolerance of MS and markedly increases the risk of thromboembolic events. AF has a negative impact on the natural history of MS and on its outcome after commissurotomy. The respective indications of rhythm and rate control should be adapted to patient characteristics, particularly the consequences of MS, and take into account the high risk of recurrence of AF. Oral anticoagulant therapy is mandatory when AF complicates MS, regardless of its severity and CHA2DS2-VASc score. Non-vitamin K antagonists oral anticoagulants are not recommended in moderate-to-severe MS due to the lack of data. Percutaneous mitral commissurotomy does not appear to prevent the occurrence of AF in MS but should be considered as the first-line therapy when AF is associated with severe symptomatic MS, followed by the discussion of cardioversion or ablation. AF ablation should be considered in patients with mitral disease requiring intervention, but the ideal timing and techniques are difficult to determine due to the lack of appropriate specific randomised trials in patients with MS.
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Lee S, Kang DH, Kim DH, Song JM, Song JK, Park SW, Park SJ. Late outcome of percutaneous mitral commissurotomy: Randomized comparison of Inoue versus double-balloon technique. Am Heart J 2017; 194:1-8. [PMID: 29223427 DOI: 10.1016/j.ahj.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Late prognosis after successful percutaneous mitral commissurotomy (PMC) is unclear. We compared late results of PMC using Inoue versus double-balloon techniques up to 25 years in a randomized trial. METHODS Between 1989 and 1995, 302 patients (77 men, 41 ± 11 years) with severe mitral stenosis were randomly assigned to undergo PMC using Inoue (n = 152; group I) or double-balloon technique (n = 150; group D). The end points were the composite events of death, mitral surgery, repeat PMC, or deterioration of New York Heart Association (NYHA) class ≥3. RESULTS During median follow-up of 20.7 years (maximum, 25.6), clinical events occurred in 82 (53.9%) patients in group I (37 deaths, 44 mitral surgeries, 9 repeat PMCs, 3 NYHA class ≥3) and in 79 (52.7%) patients in group D (34 deaths, 51 mitral surgeries, 5 repeat PMCs, 4 NYHA class ≥3). Event-free survival rates at 24 years were not significantly different between group I and group D (40.8% and 42.6%, respectively; hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.65-1.20; P = .423). On multivariate analysis, absence of post-PMC commissural mitral regurgitation (MR) (HR, 1.84; 95% CI, 1.28-2.63; P = .001) and immediate post-PMC mitral valve area (MVA) <1.8 cm2 (HR, 1.53; 95% CI, 1.04-2.25; P = .031) were independently correlated with clinical events after successful PMC. CONCLUSIONS The Inoue and double-balloon methods showed similar good clinical outcomes up to 25 years, and the achievement of effective commissurotomy to develop post-PMC commissural MR or immediate post-PMC MVA ≥1.8 cm2 is important in optimizing the late results of PMC.
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Optimal surface property for three-dimensional echo visualization. J Med Ultrason (2001) 2017; 45:213-222. [PMID: 29027037 DOI: 10.1007/s10396-017-0831-4] [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: 01/12/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Three-dimensional (3D) echo is a useful modality to guide off-pump intracardiac surgery, and this study aimed to determine the optimal surface property for minimizing echo dropout and grating lobes. METHODS A total of 13 specimens were examined. The specimens were scanned while they were rotated from 0° to 90°, and en face views were recorded in the 3D zoom mode. Changes in brightness were compared with the surface profile, which was traced from microscopic images. The brightness and size of grating lobes were also examined. RESULTS Decreases in brightness that were observed at a large rotation angle were classified into three groups (sharp, moderate, and gradual), and variation in the effective reflective plane size appeared to be a major determinant of this property. The same material showed different degrees of reflection depending on the surface profile. The size of grating lobes was affected by variation in the reflective plane size, but not by the intensity of reflection. The brightness of the grating lobes was similar among specimens. CONCLUSIONS These results suggest that echo dropout and grating lobes can be effectively eliminated by an appropriate surface profile; thus, a likely practical solution would be to manufacture a surface that provides an adequate reflective surface size at various incident angles.
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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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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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Rathakrisnnan SS, Ramasamy R, Kaliappan T, Gopalan R, Palanimuthu R, Anandhan P. Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy. J Clin Diagn Res 2017; 11:OC18-OC20. [PMID: 28384909 DOI: 10.7860/jcdr/2017/24234.9345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres. AIM To assess the immediate post procedure outcome of over the wire BMV with JOMIVA balloon. MATERIALS AND METHODS Clinical and echocardiographic parameters of pregnant women with significant mitral stenosis who underwent elective BMV with JOMIVA balloon in our institute from 2005 to 2015 were analysed retrospectively. Severity of breathlessness (New York Heart Association Functional Class), and duration of pregnancy was included in the analysis. Pre procedural echocardiographic parameters which included severity of mitral stenosis and Wilkin's scoring were analysed. Clinical, haemodynamic and echocardiographic outcomes immediately after the procedure were analysed. RESULTS Among the patients who underwent BMV in our Institute 38 were pregnant women. Twenty four patients (63%) were in New York Heart Association (NYHA) Class III. All of them were in sinus rhythm except two (5%) who had atrial fibrillation. Thirty four patients (89.5%) were in second trimester of pregnancy at the time of presentation and four (10.5%) were in third trimester. Echocardiographic analysis of the mitral valve showed that the mean Wilkin's score was 7.3. Mean mitral valve area pre procedure was 0.8 cm2. Mean gradient across the valve was 18 mmHg. Ten patients (26.5%) had mild mitral regurgitation and none had more than mild mitral regurgitation. Thirty six patients had pulmonary hypertension as assessed by tricuspid regurgitation jet velocity. All of them underwent BMV with JOMIVA balloon. Post procedure mean mitral valve area was 1.7 cm2 as assessed by echocardiography. Post procedure mean gradient across the mitral valve as assessed by echocardiography was 5 mmHg. Two patients had moderate to severe mitral regurgitation after the procedure and the rest had either no mitral regurgitation or mild mitral regurgitation after the procedure. None of the patients warranted mitral valve replacement after BMV. No patients had any manifestations of systemic embolism like cerebrovascular accident or limb ischemia after the procedure. None of the patients had preterm delivery or adverse fetal outcome during index hospitalisation. CONCLUSION Over the wire BMV is safe and effective method during pregnancy. The results are comparable to that of Inoue technique. BMV offers a good symptomatic improvement in pregnant women presenting with symptoms of pulmonary congestion because of Rheumatic mitral stenosis.
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Affiliation(s)
- Shanmuga Sundaram Rathakrisnnan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Ramona Ramasamy
- Resident, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Rajendiran Gopalan
- Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Ramasmy Palanimuthu
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Premkrishna Anandhan
- Assistant Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
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Abstract
Primarily affecting the young, rheumatic heart disease (RHD) is a neglected chronic disease commonly causing premature morbidity and mortality among the global poor. Standard clinical prevention and treatment is based on studies from the early antimicrobial era, as research investment halted soon after the virtual eradication of the disease from developed countries. The emergence of new global data on disease burden, new technologies, and a global health equity platform have revitalized interest and investment in RHD. This review surveys past and current evidence for standard RHD diagnosis and treatment, highlighting gaps in knowledge.
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Affiliation(s)
- Shanti Nulu
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, New Haven, CT 06519, USA
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, 641 Huntington Avenue, Boston, MA 02115, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Gene F Kwan
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA; Section of Cardiovascular Medicine, Boston University Medical Center, Boston University School of Medicine, 88 East Newton Street, D8, Boston, MA 02118, USA.
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Sundaram S, Kaliappan T, Gopalan R, Palanimuthu R, Anandhan P, Joseph RM. Mechanism and Immediate Outcome of Significant Mitral Regurgitation Following Balloon Mitral Valvuloplasty with JOMIVA Balloon. J Clin Diagn Res 2017; 11:OC01-OC04. [PMID: 28511424 DOI: 10.7860/jcdr/2017/24202.9333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Balloon Mitral Valvuloplasty (BMV) with inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique with Joseph Mitral Valvuloplasty (JOMIVA) balloon and is being followed in certain centres. We hypothesized that, the incidence and mechanism of Mitral Regurgitation (MR) is likely to be different from that of inoue balloon. AIM To assess the mechanism and immediate clinical outcome of significant MR following BMV with JOMIVA balloon retrospectively. MATERIALS AND METHODS We retrospectively analyzed the outcome of 48 patients who developed moderate to severe MR out of 249 patients who underwent BMV in our institute. We analyzed the echocardiographic and clinical parameters of these patients. RESULTS Nineteen (7.6%) patients developed severe MR and 29 (11.2%) patients developed moderate MR. Commisural separation resulting in MR was the most common cause which was contributing to 73.6 % and 85.7% of patients with moderate and severe MR respectively. Leaflet tear was the second most common cause which contributed to 15.7% and 14.2% of patients with severe and moderate MR respectively. Chordal rupture contributed to 10.5% of patients with severe MR. Six (31.6%) patients with severe MR developed worsening breathlessness among them one had to be referred for mitral valve replacement during index hospitalization and the rest could be managed medically. Patients with moderate MR remained asymptomatic and stable. CONCLUSION Severe MR following JOMIVA BMV results most commonly due to wide separation of commisures. JOMIVA balloon is less likely to cause damage to subvalvular structures than inoue balloon. Most patients who develop severe MR will not require emergency mitral valve replacement. Moderate MR is well tolerated clinically.
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Affiliation(s)
- Shanmuga Sundaram
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajendiran Gopalan
- Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Ramasamy Palanimuthu
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Premkrishna Anandhan
- Assistant Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rinku Mary Joseph
- Clinical Pharmacist, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Sarmiento RA, Blanco R, Gigena G, Lax J, Escudero AG, Blanco F, Szarfer J, Solerno R, Tajer CD, Gagliardi JA. Initial Results and Long-Term Follow-up of Percutaneous Mitral Valvuloplasty in Patients with Pulmonary Hypertension. Heart Lung Circ 2017; 26:58-63. [DOI: 10.1016/j.hlc.2016.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/28/2022]
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Barros-Gomes S, Eleid MF, Dahl JS, Pislaru C, Nishimura RA, Pellikka PA, Pislaru SV. Predicting outcomes after percutaneous mitral balloon valvotomy: the impact of left ventricular strain imaging. Eur Heart J Cardiovasc Imaging 2016; 18:763-771. [DOI: 10.1093/ehjci/jew160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 07/06/2016] [Indexed: 01/19/2023] Open
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Predictors of Very Late Events After Percutaneous Mitral Valvuloplasty in Patients With Mitral Stenosis. Am J Cardiol 2016; 117:1978-84. [PMID: 27131615 DOI: 10.1016/j.amjcard.2016.03.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 11/21/2022]
Abstract
Data on long-term outcomes of percutaneous mitral valvuloplasty (PMV) are still scarce. In addition, the persistence of pulmonary hypertension (PH) after PMV is a complication for which mechanisms and prognostic implications are unclear. Our aims were (1) to report the long-term outcomes of patients with rheumatic mitral stenosis treated with PMV; (2) to determine the risk factors for long-term poor outcomes; and (3) to analyze the prevalence and predictors of persistent PH. We prospectively enrolled 532 patients who underwent PMV from 1987 to 2011 at 2 hospitals. The following end points were assessed after PMV: all-cause mortality, mitral reintervention, a composite end point of all-cause mortality and mitral reintervention, and PH persistence. Survival status was available for 97% patients; the median follow-up was 10 years (interquartile range 4 to 18 years). Procedural success was achieved in 85% patients. During the follow-up, 21% patients died and 27% required mitral reintervention. Before PMV, 74% patients had PH that persisted after PMV in 45% of patients (p <0.001). Unfavorable valve anatomy (Wilkins score >8) and post-PMV mean pulmonary arterial pressure (PAP) were independent predictors of all-cause mortality, mitral reintervention, and the composite end point. Post-PMV mean PAP was significantly correlated with a mitral valve area (MVA) <2.5 cm(2) (p <0.001); in addition, on the echocardiographic follow-up, MVA was an independent predictor of systolic PAP (p <0.001). In conclusion, PMV represents an advantageous therapeutic option for patients with mitral stenosis in terms of long-term outcomes. Unfavorable valve anatomy and persistent PH were the most important predictors of long-term outcomes. The persistence of PH is associated with the MVA obtained after PMV.
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