medigraphic.com

2007, Number 2

<< Back Next >>

Arch Cardiol Mex 2007; 77 (2)

Long-term results of percutaneous mitral valvuloplasty in patients over 50 years old

Astudillo R, Palomo VJA, Santiago J, Montoya S, Flores J, Estrada J, Abundes A, González B, Farell J

Language: Spanish
References: 40
Page: 101-109
PDF size: 120.73 Kb.


ABSTRACT

Advanced age has been identified as a predictor factor for complications and poor outcome at Percutaneous Mitral Valvulotomy (PMV) with balloon, nevertheless this has been associated to the inadequate valvular anatomy, whereby the contribution of each factor needs to be determinate. Objective: Describe the immediate and final outcome of PMV with Inoue balloon in patients over 50 years old and associate complications with age and Wilkins score. Material and methods: A retrospective and analytic study was performed with a data base of 430 patients. We included all the patients proceeding from the Centro Médico Nacional Siglo XXI Cardiology Hospital. From January 1996 to December 2005. Results: We selected 137 patients with rheumatic mitral stenosis. We found a Mitral Valvular Area (MVA) before the PMV proceeding of 1.01 cm2 ± 0.18 and 1.99 cm2 ± 0.30 post PMV (P ‹ 0.001), with pre procedure transmitral gradient of 14.3 ± 3.18 mm Hg and of 4.3 ± 2.6 mm Hg post (P ‹ 0.001). In 128 (93%) the immediate proceeding was considered successful. The Wilkins score was 8.41 ± 1.31. The observed complications were present in 19 (13.8%), stroke in 3 (2.2%), tamponade in 3 (2.2%), conduction disorder in 5 (3.7%), severe mitral insufficiency in 7 (5.1%), residual interatrial communication in 1 (0.7%). A clinical and echocardiographic follow-up was performed in 113 (83%) MVA was › 1.5 cm2 in 113 at 70 [IBM1] months average, 1.1 to 1.49 cm2 in 14 (10.2%) and ‹ 1 cm2 in 9 (7%). Conclusions: PMV with Inoue balloon in patients over 50 years old is a procedure with an immediate high successful index and of acceptable risk. We found a restenosis index of 27 (19%) after long follow-up 70 months average.


REFERENCES

  1. 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; 87: 394-402.

  2. Inoue K, Feldman T: Percutaneous transvenous commissurotomy using the Inoue balloon. Catheter Catheterization Cardiovasc Diagn 1993; 28: 119-125.

  3. Lock J, Khalilullah M, Shrivastava S, Bahl V, Keane J: Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med 1985; 313: 1515-1518.

  4. Babic U, Pejcic P, Djurisic Z, Vucinic M, Grujicic S: Percutaneous transarterial balloon valvuloplasty for mitral valve stenosis. Am J Cardiol 1986; 57: 1101-1104.

  5. Herrmann H, Kleaveland J, Hillja M, Margolis J, Nicero M: The M-Heart balloon mitral valvuloplasty registry: Initial results and early follow up. J Am Coll Cardiol 1990; 15: 1221-1226.

  6. Multicenter experience with balloon mitral commissurotomy. NHLBI balloon Valvuloplasty Registry report on immediate and 30 days follow up results. The National Heart, Lung and Blood Institute Balloon Valvuloplasty Registry Participants. Circulation 1992; 85: 448-461.

  7. Feldman T, Carroll D, Isner M, Chisholm J, Holmes R, Masumi A, Inoue K, et al: Effects of valve deformity on results and mitral regurgitation after Inoue balloon commissurotomy. Circulation 1992; 85: 180-187.

  8. Al Zaibag M, Ribeiro A, Al Kasab S, Al Fagih M: Percutaneous double balloon mitral valvotomy for rheumatic mitral valve stenosis. Lancet 1986; 1: 757-761.

  9. Hernandez R, Bañuelos C, Alfonso F, Goicolea J, Fernandez-Ortiz A, Escaned J, et al: Long-term clinical and echocardiographic follow-up after Percutaneous Mitral Valvuloplasty with the Inoue Balloon. Circulation 1999; 99: 1580-1586.

  10. Martínez-Reding J, Cordero J, Romero A, Ban Hayashi E, Alvarado G, Kuri J: Valvuloplastía mitral percutánea con balón de Inoue. Experiencia inicial y seguimiento clínico a 3 años en el Instituto Nal. de Cardiología “Ignacio Chávez”. Arch Inst Cardiol Méx 1994; 64(6): 537-42.

  11. Hermann HC, Ramaswamy K, Isner J, Feldman T, Carroll J, Pichard A, et al: Factors influencing immediate results, complications, and short-term follow-up status after Inoue balloon mitral valvotomy: A North American multicenter study. Am Heart J 1992; 124(1):160-166.

  12. Gamra C, Habib L, Zhang Ch, Heping R: Factors determining normalization of pulmonary vascular resistance following successful balloon mitral valvuloplasty. Am J Cardiol 1999; 83(3): 392-95.

  13. Vahanian A: Balloon Valvuloplasty. Heart 2001; 85(2): 223-228.

  14. Mohamede E, Layth M, Vas S, Jayaram L, Ashfac P, Khan B, et al: Immediate and long-term effect of mitral balloon valvotomy on severe pulmonary hypertension in patients with mitral stenosis. Am Heart J 1996; 131(1): 89-93.

  15. Treviño J, Ibarra M, García A, Uribe A, De la Fuente F, Bonfil A, Feldman T: Immediate and long-term results of balloon mitral commissurotomy for rheumatic mitral stenosis: Comparison between Inoue and double-balloon techniques. Am Heart J 1996;131(3): 530-536

  16. Osa A, Almenar L, Rincón de Arellano L, Martí S, Roldán I, García E, et al: Resultados a largo plazo de la valvuloplastía mitral percutánea. Rev Esp Cardiol 1998; 51(6): 458-466.

  17. Lung B, Garbaz E, Michaud P, Helou S, Farah B, Berdah P, et al: Late results of percutaneous mitral commissurotomy in a series of 1,024 patients. Circulation 1999; 99: 3272-3278.

  18. Cheng C, Cheng T: Long-term results of percutaneous balloon mitral valvuloplasty using the Inoue balloon catheter technique. Am Heart J 1995; 129: 1197-1204.

  19. Ledesma M, Treviño A, Delgado G, Martínez A, Murillo H, Munayer J, et al: Registro Nacional de Comisurotomía Mitral Percutánea. Experiencia de 8 años. Arch Inst Cardiol Méx 1996; 66(3): 244-53.

  20. Wilkins T, Weyman E, Abascal M, Block C, Palacios F: Percutaneous balloon dilatation of mitral valve; an analysis of echocardiography variables related to outcomes and the mechanism of dilatation. Br Heart J 1988; 60: 299-308.

  21. Ruiz C, Zhang P, Gamra H, Allen J, K Lau F: Late clinical and echocardiography follow up after percutaneous balloon dilatation of mitral valve. Br Heart J 1994; 71: 454-458.

  22. Hatle L, Anglesen J, Tromsdal A: Noninvasive assessment of atrio-ventricular pressure half time by Doppler ultrasound. Circulation 1979; 60: 1094-1104.

  23. Abascal R, Wilkins T, O’Shea L: Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvuloplasty. Circulation 1990; 82: 448-56.

  24. Sellers D, Levy J, Amplatz K, Zellehe W: Left retrograde cardioangiography in acquired cardiac disease: technique, indications and interpretation of 700 cases. Am J Cardiol 1964; 14: 437- 447.

  25. Hernandez R, Macaya C, Bañuelos C, Alfonso F, Goicolea J, Iñigues A: Predictors, mechanisms and outcomes of several mitral regurgitation complicating percutaneous mitral valvulotomy with the Inoue balloon. Am J Cardiol 1992; 70: 1169-1174.

  26. Feldman T: Hemodynamics results, clinical outcome, and complications of Inoue balloon mitral valvotomy. Cathet Cardiovasc Diagn 1994; 33(Suppl 2): 2-7.

  27. Hung B, Cormier B, Ducimetiere P, Porte J, Nallet O, Michel P, et al: Immediate results of mitral percutaneous mitral commissurotomy. Circulation 1996: 94; 2124-2130.

  28. Nobuyoshi M, Hamashaki H, Kimura T, Nosaka H, Yokoi H, Yasumoto H, et al: Indications, complications and short term clinical outcome of percutaneous transvenous mitral commissurotomy. Circulation 1989: 80; 782-792.

  29. Hung J, Cheng M, Wu J, Fu M, Yeh K, Wu Y, et al: Short and Long term results of Catheter Balloon Percutaneous Transvenous Mitral Commissurotomy. Am J Cardiol 1991; 67: 854-862.

  30. Hung J, Kean W: Pitfalls and Tips in Inoue Balloon Mitral Commissurotomy. Cathet Cardiovasc Diagn 1996; 37: 188-199.

  31. Vahanian A, Michel P, Cormier B, Vitoux B, Michel X, Slama M, et al: Results of percutaneous mitral commissurotomy in 200 patients. Am J Cardiol 1989; 63: 847-852.

  32. Palacios I, Sanchez P, Harrell L, Weyman A, Block P: Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variable that predict long-term outcome. Circulation 2002; 105: 1465-1471.

  33. Flores J, Ledesma M, Palomo J, Montoya S, Estrada J, Astudillo R, et al: Resultados a largo plazo de la valvuloplastía mitral percutánea con técnica de Inoue. Experiencia de 7 años del Hospital de Cardiología del CMN Siglo XXI. IMSS. Arch Cardiol Mex 2006; 76: 28-36.

  34. Bonow RO, Carabello B: ACC/AHA guidelines for de management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 1998; 32: 1486-588.

  35. Mazur W, Parilak L, Kaluza G, DeFelice C, Raizner A: Balloon valvuloplasty for mitral stenosis. Curr Opin Cardiol 1999; 14(2): 95-104.

  36. Ben Farhat M, Ayari M, Maatouk F Al: Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven year follow-up results of a randomize trial. Circulation 1998; 97: 245-250.

  37. Sutaria N, Elder A, Shaw T: Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over. Heart 2000; 83(4): 433-438.

  38. Harrison K, Wilson S, Hearne E, Bashore M: Complications related to percutaneous transvenous mitral commissurotomy. Cathet Cardiovasc Diagn 1994; 33(Suppl 2): 52-60.

  39. Ben M, Betbout F, Gamra H, Maatouk F, Ayari M, Cherif A, et al: Results of percutaneous double-balloon mitral commissurotomy in one Medical Center in Tunisia. Am J Cardiol 1995; 76: 1266-70.

  40. Ruiz C, Ping H, Gamra H, Allen J, Y K Lau F: Late clinical and echocardiography follow up after percutaneous balloon dilatation of the mitral valve. Br Heart J 1994; 71: 454-58.




2020     |     www.medigraphic.com