Additive value of 3D-echo in prediction of immediate outcome after percutaneous balloon mitral valvuloplasty

Abstract

BackgroundResults of percutaneous balloon mitral valvuloplasty (BMV) are basically dependent on suitable patient selection. Currently used two-dimensional (2D) echocardiography (2DE) scores have many limitations. Three-dimensional (3D) echocardiography (3DE)-based scores were developed for better patient selection and outcome prediction. We aimed to compare between 3D-Anwar and 2D-Wilkins scores in mitral assessment for BMV, and investigate the additive value of 3DE in prediction of immediate post-procedural outcome. Fifty patients with rheumatic mitral stenosis and candidates for BMV were included. Patients were subjected to 2D- and real-time 3D-transthoracic echocardiography (TTE) before and immediately after BMV for assessing MV area (MVA), 2D-Wilkins and 3D-Anwar score, commissural splitting, and mitral regurgitation (MR). Transesophageal echocardiography (TEE) was also undertaken immediately before and intra-procedural. Percutaneous BMV was performed by either multi-track or Inoue balloon technique.ResultsThe 2DE underestimated post-procedural MVA than 3DE (p = 0.008). Patients with post-procedural suboptimal MVA or significant MR had higher 3D-Anwar score compared to 2D-Wilkins score (p = 0.008 and p = 0.03 respectively). The 3D-Anwar score showed a negative correlation with post-procedural MVA (r = − 0.48, p = 0.001). Receiver operating characteristic (ROC) curve analysis for both scores revealed superior prediction of suboptimal results by 3D-Anwar score (p < 0.0001). The 3DE showed better post-procedural posterior-commissural splitting than 2DE (p = 0.004). Results of both multi-track and Inoue balloon were comparable except for favorable posterior-commissural splitting by multi-track balloon (p = 0.04).ConclusionThe 3DE gave valuable additive data before BMV that may predict immediate post-procedural outcome and suboptimal results.Electronic supplementary materialThe online version of this article (10.1186/s43044-019-0019-x) contains supplementary material, which is available to authorized users.

Two-dimensional-Wilkins and real-time transesophageal three-dimensional scoring systems: Which one is preferred to mitral valve morphological assessment?

“…However, given that each of these scoring has unique advantages, it is first necessary to determine the degree of agreement between these two types of scoring systems, and on the other hand, it can be assumed that by taking advantage of each of these two systems, it will be possible to propose a new scoring system to evaluate the morphology of the mitral valve in affected patients. 20…”

Mitral leaflet separation index for mitral valve assessment during balloon mitral valvuloplasty

“…2D MVA and PHT are considered the standard but the techniques have limitations, for example a difficult window and an extensive calcification shadow 6,7 . 3D TTE or TEE recently emerged as a valuable tool but is not widely available in developing countries 2,8 . The search for a quick test with high accuracy has been an advantage for MSLI 9–12 …”

“…Mitral stenosis (MS), in particular, is challenging to manage. Adequate mitral valve area assessment is an important step before percutaneous mitral balloon valvuloplasty (PBMV) or surgical management 2 …”

3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time

“…In this 3D score, with a maximum of 31 points (6 for thickness, 6 for mobility, 10 for calcification, 9 for subvalvular apparatus involvement), mitral valve stenosis can be graded as mild (<8), moderate (8-13), or severe (≥14). It seems that 3D echocardiography can better observe subvalvular involvement (72) and provide commissural observation after valvuloplasty (73)(74)(75).…”

“…Considering percutaneous balloon mitral valvuloplasty, 3D echocardiography-based scores provided additive information that could predict post-procedural outcome and suboptimal results. 3D echocardiographic analysis enabled a more comprehensive observation of post-procedural posterior-commissural splitting when compared to 2D observation ( 74 ).…”