Prosthetic mitral valvuloplasty

Abstract

A 78-year-old man underwent mitral valve replacement with a no. 33 Hancock porcine bioprosthesis for severe mitral regurgitation. Postoperatively, a transthoracic echocardiogram (TTE) revealed a mean mitral valve gradient (MVG) of 4 mm Hg, a calculated mitral valve area (MVA) of 2.8 cm(2), and no mitral regurgitation. Eighteen months later, he presented to the emergency room with progressive dyspnea. Repeat TTE demonstrated severe mitral stenosis (MVG, 16 mm Hg; MVA, 0.9 cm(2)). The patient was deemed high risk for a repeat valve replacement, and percutaneous valvuloplasty was performed with an Inoue balloon catheter inflated to 26 mm. The patient's symptoms dramatically improved, as did his hemodynamics (MVG, 5 mm Hg; MVA, 1.6 cm(2)). There was no evidence of mitral regurgitation and the successful results were maintained after 10 months of follow-up. Since its introduction in 1987, there have been only nine cases reporting successful balloon valvulotomy in prosthetic mitral valves. While percutaneous valvulotomy is the intervention of choice for native mitral stenosis, it is rarely performed in prosthetic valves, with surgical valve replacement being the treatment of choice. Our case was successful and may suggest a niche to reconsider using the procedure in certain clinical circumstances.

Percutaneous balloon valvuloplasty for bioprosthetic mitral valve stenosis

“…However, the reports regarding balloon valvuloplasty for bioprosthetic valve failure in adult patients are extremely limited. A literature search identified 26 cases of balloon valvuloplasty for degenerated bioprosthetic valve; 14 cases in mitral position [6][7][8][9][10][11][12][13][14][15][16], 6 cases in aortic position [17,18,16,19,20], 4 cases in tricuspid position [21][22][23][24], and 2 case in pulmonary position (Table 2) [27]. We cannot draw any concrete conclusions from these limited experiences, more case reports are needed to establish a base for future expert recommendation of balloon valvuloplasty of prosthetic mitral valve.…”