The efficiency and safety of balloon valvuloplasty in patients with mitral stenosis and a high echo score: mid- and short-term clinical and echocardiographic results

Objectives: We aimed to evaluate the success and safety of percutaneous mitral balloon valvuloplasty (PMBV) and its mid-term clinical and echocardiographic results in patients with symptomatic mitral stenosis, including those having a high echo score (9 to 11).
Study design: This prospective study included 57 consecutive patients (9 men, 48 women; mean age 41±9 years) who underwent PMBV with the Inoue technique for symptomatic (NYHA class II-IV) mitral stenosis (valve area <1.5 cm2). The patients were divided into two groups according to the echo scores of ≤8 (group 1, n=25) and >8 (group 2, n=32). Clinical and echocardiographic evaluations were performed before and after 24-48 hours of PMBV and during the follow-up period, including restenosis and major cardiovascular events.
Results: Patients in group 2 had significantly higher rates of atrial fibrillation (53.1% vs. 16%; p=0.006) and functional capacity of NYHA class III-IV (%90.7 vs. %56; p=0.01). Procedural success rates were 96% (n=24) and 90.6% (n=29) in group 1 and 2, respectively. Failure occurred in one patient (4%) in group 1, and in three patients (9.4%) in group 2. One patient in group 1 developed severe mitral stenosis resulting in valve replacement. In group 2, two patients developed hemopericardium. After the procedure, there was a two-fold increase from 1.0±0.1 cm2 to 2.0±0.2 cm2 in the mean valve area, being more prominent in group 1 (group 1: from 1.1±0.1 cm2 to 2.1±0.1 cm2; group 2: from 0.9±0.1 cm2 to 1.8±0.1 cm2; p<0.001). In-hospital mortality or embolic events did not occur, nor did restenosis or major cardiovascular events during a mean follow-up of 21±13 months.
Conclusion: Our results show that PMBV can be performed successfully in patients having a low (≤8) or higher (9-11) echo score, with satisfactory hemodynamic and symptomatic improvements.

Keywords: Balloon dilatation, echocardiography, hemodynamics, mitral valve stenosis/therapy