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. 2009 Feb 3;23(9):673–677. doi: 10.1002/clc.4960230908

Hemodynamic effects and long‐term outcome of percutaneous balloon valvuloplasty in patients with mitral stenosis and atrial fibrillation

Elizabeth A Tarka 1, Lawrence R Blitz 1, Howard C Herrmann 1,✉
PMCID: PMC6654854  PMID: 11016017

Abstract

Background: The presence of atrial fibrillation (AF) has been identified as a predictor of a suboptimal result in some patients undergoing percutaneous balloon valvuloplasty in the treatment of symptomatic rheumatic mitral stenosis.

Hypothesis: Atrial fibrillation adversely affects the short‐and long‐term outcome of patients with mitral stenosis undergoing percutaneous balloon valvuloplasty.

Methods: A retrospective chart review of 104 consecutive patients with rheumatic mitral stenosis undergoing percutaneous balloon valvuloplasty was performed. A successful procedure was defined as a final mitral valve area ≤ 1.5 cm2 and the absence of a complication. Endpoints included freedom from mitral valve replacement, death, and repeat balloon valvuloplasty at 5 years.

Results: A successful procedure was obtained in 89% of patients with sinus rhythm and in 78% of patients with AF (p = NS). Patients in sinus rhythm had a greater cardiac output resulting in a larger final valve area than patients in AF (1.8 vs. 1.6 cm2, p<0.05). Freedom from valve replacement, death, and repeat balloon valvuloplasty at 5 years was 75% for patients in AF and 76% for patients in sinus rhythm (p = NS). Lower postprocedure mitral regurgitation grade and absence of prior commissurotomy were the only independent predictors of event‐free survival.

Conclusions: Patients with mitral stenosis and AF have lower cardiac outputs and gradients than patients with sinus rhythm, despite similar valve areas. The long‐term outcome of balloon valvuloplasty is independent of the initial cardiac rhythm.

Keywords: rheumatic mitral stenosis, valvuloplasty, atrial fibrillation

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