Mitral Regurgitation After Percutaneous Mitral Valvuloplasty

Nunes, Maria Carmo Pereira; Levine, Robert A.; Braulio, Renato; Pascoal-Xavier, Marcelo Antônio; Elmariah, Sammy; Gomes, Nayana Flamini Arantes; Soares, Juliana Rodrigues; Esteves, William A. M.; Zeng, Xin; Dal‐Bianco, Jacob P.; Passos, Lívia Silva Araújo; Passaglia, Luiz Guilherme; Ribeiro, Victor Teatini; Gelape, Cláudio Léo; Costa, Patrícia S.; Lodi-Junqueira, Lucas; Dutra, Walderez Ornelas; Tan, Timothy C.; Aïkawa, Elena; Hung, Judy

doi:10.1016/j.jcmg.2020.07.020

Cited by 13 publications

(10 citation statements)

References 32 publications

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“…A number of alternative scoring systems have been proposed to separately predict the severity of MR postprocedure; however, severe MR is multifactorial, and accurate prediction requires taking into account anatomic features, including higher echo scores, 19 heavily calcified posterior leaflets, 20 dense eccentric or bilateral commissural fusion, and a severely thickened and calcified subvalvular apparatus. 21 More recent work on patients with leaflet tearing as a consequence of PBMV has shown that a particularly susceptible group are patients with uneven leaflet tissue density 22 ; in our experience, these patients are younger, and the events are difficult to predict.…”

Section: Echo Scores and Predictors Of Outcomesmentioning

confidence: 66%

“…The reported rate is widely variable and likely dependent on the quality of MR assessment, but a careful study of 342 patients in the past decade revealed an 11.9% rate of moderate and 6.7% rate of severe MR induced by ballooning. 22 The impact of post-PBMV MR on event-free survival is dependent on the type and extent of MR, with leaflet tear at the central scallop or subvalvular disruption having early correlation with (frequently emergent) mitral valve replacement and cardiac death while commissural regurgitation is to be expected and tends to improve over time as the commissures refuse. 22 Figure 8 shows an example of catastrophic MR in a patient with seemingly good anatomy but likely uneven tissue characteristics that led to differential force exerted on portions of the valve leaflet with resultant leaflet tear.…”

Section: Interventionmentioning

confidence: 99%

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The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status

Turi¹

2022

Structural Heart

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Section: Echo Scores and Predictors Of Outcomesmentioning

confidence: 66%

Section: Interventionmentioning

confidence: 99%

The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status

Turi¹

2022

Structural Heart

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“…Mitral regurgitation commonly occurs following PTMC and is often attributed to commissural splitting, which typically leads to a mild increase in MR and yields a favourable outcome. 4 Other mechanisms of MR such as leaflet tearing and subvalvular damage tend to result in severe MR with haemodynamic impairment, necessitating urgent surgery and leading to a less favourable prognosis. 4 Other complications following PTMC include cardiac tamponade, embolic events, and bleeding.…”

Section: Discussionmentioning

confidence: 99%

Papillary muscle rupture without severe mitral regurgitation following percutaneous balloon mitral commissurotomy: a case report

Rossignon,

Morra,

de Hemptinne

et al. 2024

European Heart Journal - Case Reports

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Background Percutaneous transvenous mitral commissurotomy (PTMC) is the first-line therapy of clinically significant rheumatic mitral stenosis. While the procedure is generally safe, new onset or aggravation of mitral regurgitation (MR) may occur, mainly due to commissural splitting and, less frequently, to leaflet tear and chordal rupture. Papillary muscle rupture (PMR) is exceedingly rare in this setting. Case presentation A 74-year-old woman with a history of aortic valve replacement and prior rheumatic mitral commissurotomy presented for worsening exercise intolerance and exertional dyspnea. Transthoracic echocardiography showed a mean pressure gradient of 10 mmHg and a mitral valve area of 1.0 cm², consistent with clinically significant mitral stenosis. Subsequent PTMC was complicated by anterolateral PMR. However, the resulting MR was unexpectedly only of mild to moderate severity. Because of residual mitral stenosis and persisting symptoms, surgical mechanical mitral valve replacement and tricuspid annuloplasty were performed 6 weeks after PTMC. PMR was confirmed during surgery. Conclusion We herein describe the occurrence of PMR induced by PTMC; the resulting MR was unexpectedly of mild to moderate severity, as a result of extensive rheumatic lesions limiting valve mobility. This case challenges the dogma according to which PMR invariably leads to severe MR. This might not be necessarily the case when it occurs following PTMC.

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“…The severity of valvular calcification and its extension is the stronger predictor of adverse events after PMBV [ 42 , 64 , 65 , 66 , 67 ].…”

Section: Know Whenmentioning

confidence: 99%

Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks

Pino

Madeo

Lucà

et al. 2023

JCM

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Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.

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Mitral Regurgitation After Percutaneous Mitral Valvuloplasty

Cited by 13 publications

References 32 publications

The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status

The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status

Papillary muscle rupture without severe mitral regurgitation following percutaneous balloon mitral commissurotomy: a case report

Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks

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