Actuarial Outcome After Catheter Balloon Commissurotomy in Patients With Mitral Stenosis

Orrange, Sharon; Kawanishi, David T.; Lopez, Becky; Curry, Susan; Rahimtoola, Shahbudin H.

doi:10.1161/01.cir.95.2.382

Cited by 97 publications

(62 citation statements)

References 48 publications

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“…Es así como Olmos y cols publicaron el año 1994 en esta revista los datos de 300 VMB realizadas en nuestro medio, confirmando los buenos resultados difundidos en la literatura 9 . Al igual que ésta, existen varias publicaciones internacionales con resultados a mediano plazo 10,11,12,13 , pero sólo unas pocas presentan datos con 10 o más años de seguimiento 14,15,16 . De esta forma, en nuestro conocimiento este trabajo representa el seguimiento más prolongado de una serie nacional de VMB.…”

Section: Discussionunclassified

Resultados a largo plazo de la valvuloplastía mitral con balón

et al. 2014

Rev. méd. Chile

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Section: Discussionunclassified

Resultados a largo plazo de la valvuloplastía mitral con balón

et al. 2014

Rev. méd. Chile

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“…4,5,7 • There are reductions of MVG, LA (PA wedge), and PA pressures, and an increase of CO; 60% of patients improve to New York Heart Association functional class (NYHA FC) I and 30% to NYHA FC II, 4,7 which has been objectively documented by exercise tests. 7 • A good immediate result is obtained in Ϸ89% of patients. 4 • A closed mitral commissurotomy in a nonrandomized study in the 1950s and 1960s has shown an improved survival in symptomatic patients (NYHA FC II and III-IV) when compared with medical therapy.…”

Section: Catheter Balloon Commissurotomymentioning

confidence: 92%

“…5 • Follow-up to 10 years after CBC shows very good eventfree survival ( Figure 3A). 4 There were no deaths in up to 7 years of follow-up, and the event rate (MVR or repeat CBC) was 10% ( Figure 3B) 7 in patients who after CBC had MVA Ն1.5cm 2 and mean PA wedge pressure Յ18 mm Hg.…”

Section: Catheter Balloon Commissurotomymentioning

confidence: 97%

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Current Evaluation and Management of Patients With Mitral Stenosis

et al. 2002

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ase presentation: A 28-year-old woman with known mitral stenosis (MS) who was not taking antibiotic prophylaxis presented with new onset of chest pain, atrial fibrillation, and "heart failure." She was treated for "heart failure" and converted spontaneously to sinus rhythm. Echocardiographic/Doppler studies showed a mitral valve gradient (MVG) of 7, a mitral valve area (MVA) of 1.2 cm 2 , 2ϩ mitral regurgitation (MR), no tricuspid regurgitation, normal left ventricular (LV) size and function, no left atrium (LA) thrombus, and a mitral valve score (University of Southern California [USC] scoring system) of 1, with no calcium in the commissures. At cardiac catheterization, mean pulmonary artery (PA) wedge was 23 mm Hg, mean PA pressure was 25 mm Hg, MVG was 10 mm Hg, and MVA was 1.2 cm 2 . On exercise, mean PA wedge was 30 mm Hg, mean PA pressure was 55 mm Hg, and MVG was 18 mm Hg. On angiography, the LV end-diastolic volume was 80 mL/m 2 , ejection fraction was 0.48, and 2ϩ MR, with normal coronary arteries. After catheter balloon commissurotomy (CBC), the MVA was 2.0 cm 2 , mean PA wedge was 13 mm Hg, and mean PA pressure was 20 mm Hg, with no MR. Her discharge medications were penicillin V 250 mg twice daily and antibiotic prophylaxis for prevention of infective endocarditis. Current Evaluations and Management of MSIn almost all patients, MS is the result of previous rheumatic carditis with valve involvement. Severity of MSThe relationship of the MVG as a function of the rate of mitral valve flow per diastolic second for various MVAs is shown in Figure 1. The threshold of onset of pulmonary edema is Ϸ20 mm Hg. Assuming a normal mean LV diastolic pressure (LVDP) of 5 mm Hg, a mean MVG of 20 mm Hg would be necessary 1 to maintain a normal cardiac output (CO). This is a level of LA pressure at which stage 2 of pulmonary edema (interstitial) would be present. An MVG of Ϸ15 mm Hg would be needed to reach stage 1 pulmonary edema (pulmonary congestion). If the LVDP were 10 mm Hg, stage 2 would be reached at a MVG of 15 mm Hg (Figure 1). The abnormalities that occur and the outcome of the patient depend on the MVA and LA pressure (Figure 2). The severity of MS can be graded on basis of the threshold of pulmonary edema at a certain cardiac output, heart rate, and MVA. The approximate values at a rate of 60 bpm are: Evaluation of Patients With MSA list of methods to diagnose MS and assess its severity and suitability for CBC, as well as to assess associated lesions, is depicted in Table 1; the important ones are highlighted. Clinical evaluation can accurately diagnose moderate or severe MS in 92% of patients. 3

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“…Although there are numerous predictors of late events following the procedure -age, functional class IV, previous surgical commissurotomy, moderate to severe mitral deficit, echo score > 8, severe mitral deficit following dilatation and increased pressure in the pulmonary artery after dilatation, small valve area after the procedure 2 ), non-sinus rhythm, valve calcification on fluoroscopy, increased LA pressure, increased transvalvular gradient [9][10][11][12][13][14][15] ; there are no details in the literature about changes of P wave in the electrocardiogram performed after the mitral valvuloplasty in patients with mitral stenosis and left atrial enlargement, and there is even less understanding about the meaning of these changes at late follow-up after the percutaneous intervention.…”

Section: Resultsmentioning

confidence: 99%