Percutaneous mitral balloon valvotomy

Abstract

Percutaneous mitral balloon valvotomy (PMBV) was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, PMBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis (MS). With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. When the reported complications of PMBV are viewed in aggregate, complications occur at approximately the following rates: mortality (0-0.5%), cerebral accident (0.5-1%), mitral regurgitation (MR) requiring surgery (1.6-3%). These complication rates compare favorably to those reported after surgical commissurotomy. Several randomized trials reported similar hemodynamic results with PMBV and surgical commissurotomy. Restenosis after PMBV ranges from 4 to 70% depending on the patient selection, valve morphology, and duration of follow up. Restenosis was encountered in 21% of the author's series at mean follow-up 6 +/- 4.5 years and the 10 and 15 years restenosis-free survival rates were (70 +/- 3)% and (44 +/- 5)%, respectively, and were significantly higher for patients with favorable mitral morphology (85 +/- 3% and 65 +/- 6%), respectively (P < 0.0001). The 10 and 15 years event-free survival rates were (79 +/- 2)% and (43 +/- 9)% and were significantly higher for patients with favorable mitral morphology (88 +/- 2)% and (66 +/- 6)%, respectively (P < 0.0001). The effect of PMBV on severe pulmonary hypertension, concomitant severe tricuspid regurgitation, left ventricular function, left atrial size, and atrial fibrillation are addressed in this review. In addition, the application of PMBV in specific clinical situations such as in children, during pregnancy and for restenosis is discussed.

Role of Echocardiographic Imaging in Percutaneous Balloon Mitral Valvotomy

“…17 Fawzy has demonstrated regression of significant TR after successful BMV in young patients with severe MS and significant PH. 18 On the other hand; Sagie et al have found no regression of TR in relatively older patients with mild PH. 19…”

Effect of Mitral Valve Leaflets Excursion on Mitral Valve area after Percutaneous Trans- Venous Mitral Commissurotomy

“…Mitral stenosis is a progressive disease that leads to heart failure and is finally fatal unless mechanical intervention enlarges the mitral valve orifice to permit adequate cardiac output at a tolerable left atrial pressure. 2 Over the past two decades PTMC has become an acceptedalternative to surgery in the treatment ofpatients with mitral stenosis. Previous studies have confirmed that this procedure is highly successful with a low complication rate and significant short-and long-term improvement in both hemodynamics and patient symptoms.…”

“…[9][10][11] Previous studies have confirmed that this procedure is highly successful with a low complication rate and significant short and long term improvement in both haemodynamic and patients symptoms. 12 Short term improvement in mitral valve area (MVA) and symptoms may occur even when commissures are not split and it may be attributed to other mechanism, such as improvement of leaflets mobility secondary to disruption of the diseased submitral tissue. 13 Evaluation of factors those determine the extent of valve leaflets mobility or excursion is necessary to predict haemodynamic changes with improved mitral leaflets excursion and outcome of PTMC.…”

Effect of Subvalvular Changes on Mitral Valve Leaflets Excursion after Percutaneous Transvenous Mitral Commissurotomy

“…Successful PTMC was defined as post valvuloplasty valve area > 1.5 cm2 or >50% increase in the mitral valve area without significant complications. 12 …”