European Heart Journal Advance Access originally published online on April 3, 2009
European Heart Journal 2009 30(10):1254-1262; doi:10.1093/eurheartj/ehp096
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Restenosis and adverse clinical events after successful percutaneous mitral valvuloplasty: immediate post-procedural mitral valve area as an important prognosticator
1 Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-ku, Seoul 138-736, South Korea
2 Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Received 10 August 2008; revised 7 February 2009; accepted 26 February 2009; online publish-ahead-of-print 3 April 2009.
* Corresponding author. Tel: +82 2 3010 3150, Fax: +82 2 486 5918, Email: jksong{at}amc.seoul.kr
Aims: We sought to investigate the factors associated with restenosis and its potential association with late clinical deterioration after successful percutaneous mitral valvuloplasty (PMV).
Methods and results: We analysed echocardiographic (median 74 months) and clinical (median 109 months) follow-up data of 329 patients who achieved procedural success, defined as mitral valve area (MVA) 
1.5 cm2 and mitral regurgitation (MR) 
2/4, between 1995 and 2000. Clinical events included cardiovascular death, mitral valve surgery, and repeat PMV. The 1, 3, 5, 7, and 9 year rates of restenosis-free survival were 99 ± 1%, 97 ± 1%, 95 ± 1%, 86 ± 3%, and 72 ± 4%, respectively. The 1, 3, 5, 7, and 9 year rates of event-free survival were 99.7 ± 0.3%, 96.4 ± 1.0%, 94.5 ± 1.3%, 90.8 ± 1.6%, and 90.0 ± 1.7%, respectively. Immediate post-PMV MVA and commissural MR or splitting, indicators of procedural adequacy, were independent predictors of both restenosis and clinical events. The best immediate post-PMV MVA cut-off value for predicting both restenosis and clinical events within 5 years after successful PMV were 1.8 cm2 [95% confidence interval (CI) = 1.7–1.9] and 1.9 cm2 (95% CI = 1.7–2.0), respectively. Patients with immediate post-PMV MVA <1.8 cm2 showed significantly lower event-free survival rate than those with post-PMV MVA 1.8 cm2 (P < 0.001).
Conclusion: Immediate post-PMV MVA1.8 cm2 was an important predictor of both restenosis- and clinical event-free survival and this value should be considered as a component of optimal result.
Key Words: Mitral stenosis • Percutaneous balloon valvuloplasty • Outcome • Echocardiography