Echocardiographic Prediction of Severe Mitral Regurgitation after Percutaneous Mitral Valvuloplasty with the Inoue Balloon

Jang, Jin Seock; Kang, Duk Hyun; Song, Jong Min; Lee, Cheol Whan; Hong, Myeong Ki; Song, Jae Kwan; Park, Seong Wook; Park, Seung Jung

Abstract

BACKGROUND AND OBJECTIVES
This study was designed to predict the development of severe mitral regurgitation (MR) following percutaneous mitral valvuloplasty (PMV) in patients with a favorable morphology of the mitral valve (MV).
SUBJECTS AND METHODS
We prospectively examined 253 patients with severe mitral stenosis from 1997 to 2000. Echocardiographic evaluation of MV morphology was performed prior to PMV. We proposed commissural calcification, severe relative prolapse, and uneven thickening of MV as predictors of MR following PMV and defined the MR risk group as patients with any of these 3 features. The balloon size was expressed as the value of the effective balloon dilating area divided by the body surface area. The larger balloon group was defined as patients in whom balloon size>3.8 cm 2/m 2 was selected for PMV. The development of severe MR was defined as the presence of MR> or = 3 + on echocardiography following PMV.
RESULTS
Severe MR developed in 14 (5.5%) patients. On multiple logistic regression analysis, the MR risk group (p<0.001) and balloon size (p=0.009) were the only significant independent predictors of severe MR following PMV. A sensitivity and specificity of a Padial MR score >8 and MR risk group was 43%, 88% and 71%, 86% respectively. In the MR risk group, severe MR developed in 8 (53.3%) of 15 patients of the larger balloon group as compared with 2 (6.9%) of 29 patients of the smaller balloon group (p=0.001).
CONCLUSION
Echocardiography can identify patients with a high risk of developing MR after PMV and the use of a smaller Inoue balloon may prevent severe MR in selected patients.