Abstract
Background: Percutaneous balloon mitral valvotomy (PBMV) has become the procedure of choice for many patients with symptomatic mitral stenosis. However, the development of significant mitral regurgitation (MR) remains an infrequent but very important complication. The echocardiographic scoring system described by Padial et al. has been successful in predicting the development of severe MR following PBMV using the double balloon technique.
Hypothesis: We aimed to assess the applicability of this new scoring system in predicting a significant increase in MR with the Inoue balloon and to compare it with the established Wilkins score.
Methods: The echocardiograms of 23 patients who had undergone PBMV for symptomatic mitral stenosis were analyzed retrospectively using both scoring systems, and the severity of MR was determined from pre‐ and postprocedure studies.
Results: Post PBMV, significant MR occurred in four patients (17%) while severe MR occurred in two patients (9%). Padial scores [mean (standard error of the mean)] in the group of patients with and without significant MR were [9.1 (0.8)] and [6.0 (0.3)], respectively (p = 0.002), while the Wilkins score was [7.5 (1.0)] and [6.4 (0.5)], respectively (p = 0.3). Using 8 as a cutoff point, the sensitivity and specificity of the newer scoring system was 83 and 100%, respectively, while the sensitivity and specificity of the Wilkins score was 50 and 50%, respectively. The positive predictive value >8 was 100% (4/4) for the Padial and 25% (1/4) for the Wilkins system. Accordingly, the negative predictive value <8 was 89% (17/19) for the Padial and 73% (14/19) for the Wilkins system.
Conclusion: The newer scoring system is better at reliably identifying patients at risk of developing significant MR from PBMV with the Inoue balloon.
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References
- 1. Essop MR, Wisenbaugh T, Skoularigis J, Middlemost S, Sareli P: Mitral regurgitation following mitral balloon valvotomy. Circulation 1991; 84: 1669–1679 [DOI] [PubMed] [Google Scholar]
- 2. Herrmann HC, Lima JAC, Feldman T, Chisholm R, Isner J, O'Neill W, Ramaswamy K: Mechanisms and outcome of severe mitral regurgitation after Inoue balloon valvuloplasty. J Am Coll Cardiol 1993; 22: 783–789 [DOI] [PubMed] [Google Scholar]
- 3. Arora R, Kalra GS, Murty GSR, Trehan V, Jolly N, Mohan JC, Sethi KK, Nigam M, Khalilullah M: Percutaneous transatrial mitral commissurotomy: Immediate and intermediate results. J Am Coll Cardiol 1994; 23: 1327–1332 [DOI] [PubMed] [Google Scholar]
- 4. Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF: Percutaneous balloon dilatation of the mitral valve: An analysis of the echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988; 60: 299–308 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Abascal VM, Wilkins GT, O'shea JP, Choong CY, Palacios IF, Thomas JD, Rosas E, Newell JB, Block PC, Weyman AE: Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation 1990; 82: 448–456 [DOI] [PubMed] [Google Scholar]
- 6. Thomas MR, Monaghan MJ, Michalis LK, Jewitt DE: Echocardiographic restenosis after successful balloon dilatation of the mitral valve with the Inoue balloon: Experience of a United Kingdom centre. Br Heart J 1993; 69: 418–423 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Cohen DJ, Kuntz RE, Gordon SPF, Plana RN, Safian RD, McKay RG, Baim DS, Grossman W, Diver DJ: Predictors of long‐term outcome after percutaneous balloon mitral valvuloplasty. N Engl J Med 1992; 327: 1329–1335 [DOI] [PubMed] [Google Scholar]
- 8. Palacios IF, Block PC, Wilkins GT, Weyman AE: Follow‐up of patients undergoing percutaneous mitral balloon valvotomy. Circulation 1989; 79: 573–579 [DOI] [PubMed] [Google Scholar]
- 9. Abascal VM, Wilkins GT, Choong CY, Block PC, Palacios IF, Weyman AE: Mitral regurgitation after percutaneous balloon mitral valvuloplasty in adults: Evaluation by pulsed Doppler echocardiography. J Am Coll Cardiol 1988; 11: 257–263 [DOI] [PubMed] [Google Scholar]
- 10. Feldman T, Carroll JD, Isner JM, Chisholm RJ, Holmes DR, Massumi A, Pichard AD, Herrmann HC, Stertzer SH, O'Neill WW, Dorros G, Sundram P, Bashore TM, Ramaswamy K, Jones LS, Inoue K: Effect of valve deformity on results and mitral regurgitation after Inoue balloon commissurotomy. Circulation 1992; 85: 180–187 [DOI] [PubMed] [Google Scholar]
- 11. Pan JP, Lin SL, Go JU, Hsu TL, Chen CY, Wang SP, Chiang BN, Chang MS: Frequency and severity of mitral regurgitation one year after balloon mitral valvuloplasty. Am J Cardiol 1991; 67: 264–268 [DOI] [PubMed] [Google Scholar]
- 12. Hernandez R, Macaya C, Banuelos C, Alfonso F, Goicolea J, Iniguez A, Fernandez‐Ortiz A, Castillo J, Aragoncillo P, Aguado MG, Zarco P: Predictors, mechanisms and outcome of severe mitral regurgitation complicating percutaneous mitral valvotomy with the Inoue balloon. Am J Cardiol 1992; 70: 1169–1174 [DOI] [PubMed] [Google Scholar]
- 13. Padial LR, Freitas N, Sagie A, Newell JB, Weyman AE, Levine RA, Palacios IF: Echocardiography can predict which patients will develop severe mitral regurgitation after percutaneous mitral valvulotomy. J Am Coll Cardiol 1996; 27: 1225–1231 [DOI] [PubMed] [Google Scholar]
- 14. Kaplan JD, Isner JM, Karas RH, Halaburka KR, Konstam MA, Hougen TJ, Cleveland RJ, Salem DN: In vitro analysis of mechanisms of balloon valvuloplasty of stenotic mitral valves. Am J Cardiol 1987; 59: 318–323 [DOI] [PubMed] [Google Scholar]
- 15. Sadee AS, Becker AE. In vitro dilatation of mitral valve stenosis: The importance of subvalvular involvement as a cause of mitral valve insufficiency. Br Heart J 1991; 65: 277–279 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Ribeiro PA, Al Zaibag M, Rajendran V, Ashmeg A, Al Kasab S, Al Faraidi Y, Halim M, Idris M, Fagih MR: Mechanism of mitral valve area increase by in vitro single and double balloon mitral valvotomy. Am J Cardiol 1988; 62: 264–269 [DOI] [PubMed] [Google Scholar]
- 17. Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N: Clinical application of transatrial mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg 1984; 87: 394–402 [PubMed] [Google Scholar]
- 18. Sellers RD, Levy MJ, Amplatz K, Zellehe CW: Left retrograde cardioangiography in acquired cardiac disease: Technique, indications and interpretation of 700 cases. Am J Cardiol 1964; 14: 437–447 [DOI] [PubMed] [Google Scholar]
- 19. Wilkins GT, Thomas JD, Abascal VM: Failure of the Doppler half‐time to accurately demonstrate change in mitral valve area following percutaneous mitral valvotomy (abstr) J Am Coll Cardiol 1987; 9: 218A [Google Scholar]
- 20. Block PC, Palacios IF, Jacos MC, Fallon JT: Mechanisms of percutaneous mitral valvotomy. Am J Cardiol 1987; 59: 318–323 [DOI] [PubMed] [Google Scholar]
- 21. Reid CL, MacKay CR, Chandrarana PAN, Kawanishi DT, Rahimtoola SH: Mechanisms of increase in mitral valve area and influence of anatomic features in double‐balloon, catheter balloon valvuloplasty in adults with rheumatic mitral stenosis: A Doppler and two‐dimensional echocardiography study. Circulation 1987; 76: 628–636 [DOI] [PubMed] [Google Scholar]
- 22. Cannan CR, Nishimura RA, Reeder GS, Ilstrup DR, Larson DR, Holmes DR, Tajik AJ: Echocardiographic assessment of commissural calcium: A simple predictor of outcome after percutaneous mitral balloon valvotomy. J Am Coll Cardiol 1997; 29: 175–180 [DOI] [PubMed] [Google Scholar]
- 23. Mezilis N, Salame M, Anagnostoy E, Ahmed J, Tennant S, Wheeldon N, Oakley D: Predicting the longterm outcome following percutaneous mitral commissurotomy with the Inoue balloon (abstr). J Am Coll Cardiol 1998; 31: 64C [Google Scholar]