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European Heart Journal 1999 20(7):519-526; doi:10.1053/euhj.1998.1338
Copyright © 1999 by the European Society of Cardiology.
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Predictors of clinical events or restenosis during follow-up after percutaneous mitral balloon valvotomy

J. Langerveld, H.W. Thijs Plokker, S.M.P.G. Ernst, J.C. Kelder and W. Jaarsmaf1

Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands

revised June 30, 1998; accepted September 30, 1998

Abstract

Aims The purpose of this study is to define predictors of events or restenosis during follow-up after percutaneous mitral balloon valvotomy.

Methods and Results Percutaneous mitral balloon valvotomy was attempted in 137 patients with severe mitral valve stenosis. In 127 patients follow-up was complete with a mean of 4·2±2·6 years. Events during follow-up were defined as death, mitral valve surgery or repeat percutaneous mitral balloon valvotomy. Restenosis was defined as a decrease in mitral valve area from ≥1·5cm2following percutaneous mitral balloon valvotomy to <1·5cm2.There was 80±4% event-free survival 4 years after percutaneous mitral balloon valvotomy. Multivariate analysis showed chronic atrial fibrillation at baseline (P=0·039, relative risk (RR)=2·5) and a high residual maximal gradient after percutaneous mitral balloon valvotomy (P=0·004, RR=2·0 per 5mmHg) to be independent predictors of an event during follow-up. The restenosis rate was 28·3% after 4 years. Chronic atrial fibrillation at baseline (P=0·0338, RR=2·2), a small mitral valve area after percutaneous mitral balloon valvotomy (P=0·0003, RR=0·8/0·1cm2) and a high residual maximal trans-mitral gradient (P=0·0252, RR=1·6/5mmHg) were all independent predictors of restenosis.

Conclusion Patients with chronic atrial fibrillation and a high maximal transmitral gradient after percutaneous mitral balloon valvotomy have a higher risk for events during follow-up. Restenosis is related to the presence of chronic atrial fibrillation at baseline and a suboptimal percutaneous mitral balloon valvotomy result.

Key Words: Mitral valve stenosis, valvuloplasty, echo-cardiography

f1 Correspondence : Dr Wybren Jaarsma, Department of Cardiololgy, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.


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