Percutaneous mitral balloon valvuloplasty - state of the art

Abstract

Since its introduction in 1982, percutaneous mitral balloon valvuloplasty (PMV) has been used successfully as an alternative to open or closed surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. PMV is safe and effective and provides sustained clinical and hemodynamic improvement in patients with mitral stenosis. The immediate and long-term results appear to be similar to those of surgical mitral commissurotomy. Proper patient selection is an essential step for being able to predict the immediate results of PMV. Candidates for PMV require precise assessment of the mitral valve morphology. The Wilkin's echocardiographic score (Echo-Sc) is currently the most widely used method for predicting PMV outcome. Leaflet mobility, leaflet thickening, valvular calcification, and sub valvular disease are each scored from 1 to 4. An inverse relationship exists between the Echo-Sc and PMV success. Both immediate and intermediate follow-up studies have shown that patients with Echo-Sc ≤ 8 have superior results, significantly greater survival, and event free survival compared to patients with Echo-Sc > 8. We identified other clinical and morphologic predictors of PMV success that include age, pre-PMV mitral valve area, history of previous surgical commissurotomy, and mitral regurgitation (MR), and post-PMV variables (e.g., post-PMV MR ≥ 3 + and pulmonary artery pressure), that may be used in conjunction with the Echo-Sc to optimally identify candidates for PMV. This concept demonstrates a multifactorial nature of the prediction of immediate and long-term results. Other echocardiographic scores have been developed for the screening of potential candidates for PMV. They include a unique score that take into account the length of the chordae. A novel quantitative score that included the ratio of the commissural areas over the maximal excursion of the leaflets from the annulus in diastole. The components of this score include mitral valve area ≤ 1 cm 2 , maximum leaflet displacement ≤ 12 mm, commissural area ratio ≥ 1.25, and sub valvular involvement. Finally, a score that is able to identify patients who are more

Catheter-Based Interventions for the Management of Valvular Heart Disease During Pregnancy

“…Because of the variability between different noninvasive methods of measuring the MVA, 91 when noninvasive estimations of the valve gradient and MVA are inconsistent with one another or with symptoms, exercise testing and invasive hemodynamic assessment should be performed to verify the severity of MS. To prevent MV replacement (MVR) prior to pregnancy, PMBC may also be considered in patients with severe symptomatic MS and with suboptimal valve anatomy (Wilkin’s score: 9-12). 92 , 93 Patients with MS and with concomitant mild-to-moderate AR, AF, or restenosis post-PMBC remain good candidates for PMBC. The management of patients with severe MS prior to pregnancy will minimize or even prevent potential clinical deterioration and reduce pharmacologic or interventional therapy during pregnancy.…”

Assessment of Awareness and Satisfaction for Patients Undergoing Percutaneous Balloon Mitral Valvuloplasty: Suggested Self-Care Guide

“…This process increases the size of the orifice, improving valvular function and helping complications from decreased cardiac output. Patients remain in the hospital 24 to 48 hours after the procedure (Palacios, 2020).…”