Effect of Hemodynamic Changes During Percutaneous Mitral Balloon Valvuloplasty on Short and Long Term Clinical Outcome

Abstract

Aims: We aim of this study is to determine whether hemodynamic changes that occur before and after percutaneous mitral balloon valvuloplasty (PMV) procedure is a predictor in determining the short- and long-term clinical results in patients with mitral stenosis (MS).

Methods: The study population consisted of 118 (26 males and 92 females) consecutive patients with symptomatic rheumatic MS, underwent successful PMV. Mean pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), mean transmitral gradient and mean left atrial was obtained before and immediately after valvuloplasty. Two separate groups were formed on the basis of these measured pressure differences. The first group pressure differences (PD) <= 15 mmHg and the second group PD > 15 mmHg.

Results: There was no difference in immediate outcomes between two group. There was no significant difference in between groups in terms of primary endpoints. However, there was a difference in mean left atrial pressure difference (LAPD) between <= 15 mmHg group and > 15mmHg group. MVR and redo PMV rates were significantly lower in LAPD> 15mmHg group (p=0.027 and p=0.03, respectively), the difference between stroke and death rates was not statistically significant (p=0.6).

Conclusion: The significant risk factors in determining long-term outcomes in patients undergoing PMV are; mitral valve morphology, atrial fibrillation, advanced age, NYHA class, post-PMV, MR grade, post-PMV MVA, prior surgical commissurotomy, post-PMV pulmonary artery pressure and echocardiographic score. In addition to these parameters we found that LAPD could also be a predictor of long term outcomes patients undergoing PMV.