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

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.

Mitral Valve Stenosis: Still a Clinical Challenge?

“…However, the small number of patients on antiarrhythmic drugs after PMBC denotes that those who cardioverted and restored SR at follow-up were most likely a minority. Despite these limitations, this important paper by Cho et al [11] provides further evidence supporting the detrimental effects of AF after PMBC. Although PMBC does not have an established antiarrhythmic action regarding incident AF despite postinterventional hemodynamic improvement, the results of their study favor an earlier intervention in asymptomatic patients with severe MVS who are at increased risk to develop permanent AF.…”

“…In this issue of Cardiology, Cho et al [11] present the results of a retrospective study of 107 patients with rMVS who underwent successful PMBC and were followed up with echocardiography for at least 10 years. The authors observed that almost half of the patients who underwent PMBC were still on SR at the very long-term follow-up and that the maintenance of the SR correlated with the presence of preprocedural SR and LA diameter < 50 mm.…”