Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1992 Jun;67(6):454–459. doi: 10.1136/hrt.67.6.454

Percutaneous balloon dilatation of the mitral valve in patients who were unsuitable for surgical treatment.

T R Shaw 1, D McAreavey 1, A R Essop 1, A D Flapan 1, A T Elder 1
PMCID: PMC1024886  PMID: 1622694

Abstract

OBJECTIVE--To assess the effects on haemodynamic function and symptoms of percutaneous balloon dilatation of mitral stenosis in patients unable to undergo surgical treatment because of associated medical/cardiac problems. DESIGN--A review of clinical outcome in 28 patients (of 108 undergoing balloon dilatation of the mitral valve) who were unsuitable for surgery. SETTING--A tertiary cardiac referral centre: some patients referred were from other cardiac centres in Scotland. PATIENTS--28 patients judged by cardiac surgeons to be unsuitable for valve replacement or valvotomy because of respiratory disease (15 patients), nonmitral cardiac disease (6), multi-organ impairment (5), psychiatric problems (1) or dense intrathoracic adhesions (1). INTERVENTIONS--Percutaneous anterograde balloon dilatation of the mitral valve with polyethylene/polyvinyl balloons in 20 patients and the Inoue balloon in eight patients. MAIN OUTCOME MEASURES--Haemodynamic variables were measured before and immediately after mitral valve dilatation. Patient survival and symptom class (New York Heart Association) were followed for a year after the procedure. RESULTS--Dilatation at the mitral orifice was achieved in all cases. The mean (SD) pressure drop across the valve fell from 13.9 (5.3) to 5.6 (2.5) mm Hg, cardiac output rose from 3.18 (1.02) to 3.96 (2.5) l/min, and valve area increased from 0.78 (0.32) to 1.58 (0.56) cm2. The procedure was well tolerated by most patients, even those with metabolic/electrolyte disturbance, severe obstructive airways disease, myocardial impairment, and coronary disease. In three patients a small shunt developed at the atrial level: none developed severe mitral reflux. The two patients who required assisted ventilation died soon after the procedure and in one patient with severe coronary artery disease myocardial infarction developed and she died in cardiogenic shock. Early symptomatic improvement was reported by 23 of the 25 survivors, though the increase in exercise capacity was often limited by their non-mitral disease. At one year follow up a further 6 patients had died because of their additional disease: 15 continued to show symptomatic improvement. CONCLUSIONS--Percutaneous balloon dilatation of the mitral valve is a useful new option in patients who are too ill to undergo cardiac surgery; but longer term benefit can be limited by the associated disease.

Full text

PDF
454

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abascal V. M., Wilkins G. T., O'Shea J. P., Choong C. Y., Palacios I. F., Thomas J. D., Rosas E., Newell J. B., Block P. C., Weyman A. E. Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation. 1990 Aug;82(2):448–456. doi: 10.1161/01.cir.82.2.448. [DOI] [PubMed] [Google Scholar]
  2. Al Zaibag M., Ribeiro P. A., Al Kasab S., Al Fagih M. R. Percutaneous double-balloon mitral valvotomy for rheumatic mitral-valve stenosis. Lancet. 1986 Apr 5;1(8484):757–761. doi: 10.1016/s0140-6736(86)91780-0. [DOI] [PubMed] [Google Scholar]
  3. Chen C. R., Huang Z. D., Lo Z. X., Cheng T. O. Comparison of single rubber-nylon balloon and double polyethylene balloon valvuloplasty in 94 patients with rheumatic mitral stenosis. Am Heart J. 1990 Jan;119(1):102–111. doi: 10.1016/s0002-8703(05)80089-4. [DOI] [PubMed] [Google Scholar]
  4. Chen C. R., Lo Z. X., Huang Z. D., Inoue K. J., Cheng T. O. Percutaneous transseptal balloon mitral valvuloplasty: the Chinese experience in 30 patients. Am Heart J. 1988 May;115(5):937–947. doi: 10.1016/0002-8703(88)90061-0. [DOI] [PubMed] [Google Scholar]
  5. Cohen M. V., Gorlin R. Modified orifice equation for the calculation of mitral valve area. Am Heart J. 1972 Dec;84(6):839–840. doi: 10.1016/0002-8703(72)90080-4. [DOI] [PubMed] [Google Scholar]
  6. Inoue K., Owaki T., Nakamura T., Kitamura F., Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984 Mar;87(3):394–402. [PubMed] [Google Scholar]
  7. Lock J. E., Khalilullah M., Shrivastava S., Bahl V., Keane J. F. Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med. 1985 Dec 12;313(24):1515–1518. doi: 10.1056/NEJM198512123132405. [DOI] [PubMed] [Google Scholar]
  8. Palacios I., Block P. C., Brandi S., Blanco P., Casal H., Pulido J. I., Munoz S., D'Empaire G., Ortega M. A., Jacobs M. Percutaneous balloon valvotomy for patients with severe mitral stenosis. Circulation. 1987 Apr;75(4):778–784. doi: 10.1161/01.cir.75.4.778. [DOI] [PubMed] [Google Scholar]
  9. Patel J., Vythilingum S., Mitha A. S. Balloon dilatation of the mitral valve by a single bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter. Br Heart J. 1990 Nov;64(5):342–346. doi: 10.1136/hrt.64.5.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Pektas O., Isik E., Coskun M., Demirkan D., Genc C., Tore H. F., Uyan C., Dokumaci B. Late hemodynamic changes in percutaneous mitral valvuloplasty. Am Heart J. 1990 Jan;119(1):112–120. doi: 10.1016/s0002-8703(05)80090-0. [DOI] [PubMed] [Google Scholar]
  11. Ruiz C. E., Allen J. W., Lau F. Y. Percutaneous double balloon valvotomy for severe rheumatic mitral stenosis. Am J Cardiol. 1990 Feb 15;65(7):473–477. doi: 10.1016/0002-9149(90)90813-g. [DOI] [PubMed] [Google Scholar]
  12. SELLERS R. D., LEVY M. J., AMPLATZ K., LILLEHEI C. W. LEFT RETROGRADE CARDIOANGIOGRAPHY IN ACQUIRED CARDIAC DISEASE: TECHNIC, INDICATIONS AND INTERPRETATIONS IN 700 CASES. Am J Cardiol. 1964 Oct;14:437–447. doi: 10.1016/0002-9149(64)90027-x. [DOI] [PubMed] [Google Scholar]
  13. Vahanian A., Michel P. L., Cormier B., Vitoux B., Michel X., Slama M., Sarano L. E., Trabelsi S., Ben Ismail M., Acar J. Results of percutaneous mitral commissurotomy in 200 patients. Am J Cardiol. 1989 Apr 1;63(12):847–852. doi: 10.1016/0002-9149(89)90055-6. [DOI] [PubMed] [Google Scholar]
  14. Wilkins G. T., Weyman A. E., Abascal V. M., Block P. C., Palacios I. F. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988 Oct;60(4):299–308. doi: 10.1136/hrt.60.4.299. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES