Role of three dimensional transesophageal echocardiography in predicting mitral regurgitation after percutaneous balloon mitral valvuloplasty

Abstract

BackgroundPercutaneous balloon mitral valvuloplasty (PBMV) can be complicated with significant mitral regurgitation (MR). We performed a pilot, prospective study to evaluate the role of three dimensional transesophageal echocardiography (3D-TEE) in the prediction of MR after PBMV through mitral valve quantification (MVQ).MethodsBetween October 2014 and October 2016, 37 patients with rheumatic, moderate-to-severe mitral stenosis, referred to the Cath lab of Bab Alshearia University hospitals for PBMV, were divided into two age and sex matched groups. Group I included 25 patients without significant MR following PBMV [vena contract area (VCA) <0.4 cm2], while group II included 12 patients with significant MR after PBMV [VCA ≥0.4 cm2]. Both groups were comparable in terms of TEE data, Wilkins score for favorability of PBMV and baseline hemodynamics.ResultsData from MVQ showed that both groups were comparable (p > 0.05) in terms of MV annulus quantification (Anteroposterior diameter, annular sphericity, 3D area and height), MV scallops (A1, A2, A3, P1, P2 and P3) areas, as well as A1 and A2 tenting volumes. However, we recorded significant differences between the two groups as regard total MV, A2, P2 and P3 tenting volumes (p < 0.05) and tenting height (p = 0.03), as well as A2, A3 and P2 prolapse volumes (p < 0.05). Moreover, our data showed a significant difference between both groups in terms of MV coaptation heights (p = 0.01), but not in anterior coaptation length (p = 0.13).ConclusionMitral valve quantification through 3D-TEE is a simple automated method, easily applicable to patients before PBMV. Moreover, MVQ-derived data, such as MV scallops' tenting and prolapse volumes, coaptation heights, and exposed and total A2 lengths may predict the possibility of significant MR after PBMV.

Procedural success and outcomes after percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis with moderate mitral regurgitation: a retrospective cohort study

“…Echocardiographic information including degree and symmetry of commissural calcification have been reported to be predictive for MR deterioration ( 24 , 30 ). Novel parameters derived from the three-dimensional transesophageal echocardiography such as scallop tenting, prolapse volumes or heights of coaptation may be useful for predicting severe MR after PBMV ( 31 , 32 ). Other imaging modalities such as cardiac magnetic resonance imaging may provide additional information on calcium distribution and can be less operator dependent ( 33 ).…”

Predictors of Complications during Percutaneous Multitrack Balloon Mitral Valvuloplasty

“…The results of the current study showed that multitrack balloon technique can significantly improve MS as proved by significant reduction of the means of gradient pressure, RVSP, and LA pressure. Actually, PMV is an effective procedure for MS with any of its technique either by Inoue balloon, metallic commissurotome, or multitrack double balloon as reported by Sharieff et al [9], Sherif et al [10], Sowdagar and Subba [11], Alkhouly et al [12].…”