Skip Navigation

European Heart Journal 2000 21(20):1690-1697; doi:10.1053/euhj.2000.2241
Copyright © 2000 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (5)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Hildick-Smith, D.J.R
Right arrow Articles by Shapiro, L.M
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hildick-Smith, D.J.R
Right arrow Articles by Shapiro, L.M
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Inoue balloon mitral valvuloplasty: long-term clinical and echocardiographic follow-up of a predominantly unfavourable population

D.J.R Hildick-Smithf1, G.J Taylor and L.M Shapiro

Cardiac Unit, Papworth Hospital, Cambridge, U.K.

Received March 20, 2000; accepted March 27, 2000

Abstract

Aims To assess long-term outcome in a typical Western population of predominantly unfavourable patients undergoing Inoue balloon mitral valvuloplasty. Outcome amongst patients has only been undertaken in the medium term. Long-term echocardiographic data in particular are scarce.

Methods Inoue mitral valvuloplasty was attempted in 106 patients. There were six technical failures; the procedure was therefore completed in 100 patients, who underwent annual clinical and echocardiographic follow-up.

Results Patients were aged 63·5±10·3 years. 82% were female. Unfavourable characteristics included age >65 (52%), NYHA class III or IV (87%), ≥1 significant co-morbidity (63%), atrial fibrillation (82%), previous surgical commissurotomy (25%) and echocardiographic score >8 (59%, mean 8·9±2·1). Mitral valve area increased from 0·98±0·23 to 1·54±0·31cm2. There were three major complications. Post-procedure, symptoms improved in 88% of patients. Haemodynamic success (mitral valve area increase >50%, final mitral valve area >1·5cm2, mitral regurgitation ≤grade 2) was achieved in 61% of cases. Mean follow-up was 4·3±1·4 years. Survival was 97%, 88% and 82% at 1, 3 and 6 years. Event-free survival (freedom from death, mitral valve replacement or repeat valvuloplasty) was 96%, 82% and 56% at 1, 3 and 6 years. Freedom from restenosis (loss of >50% gain in mitral valve area, mitral valve area <1·5cm2) was 98%, 92% and 75% at 1, 3 and 6 years. Pre-procedural predictors of event-free survival were male sex, absence of co-morbidities, lower echocardiographic score and smaller left atrial diameter.

Conclusions In a Western population with predominantly unfavourable characteristics for mitral valvuloplasty, long-term outcome post-procedure is reasonable. A moderate increase in mitral valve area can be achieved at low procedural risk, and the subsequent rate of restenosis is low. Nonetheless, 6 years after the procedure, half of the patients will have required further intervention or died. For fitter patients willing to accept significant operative risk, mitral valve replacement remains a valuable alternative.

Key Words: Mitral valvuloplasty, inoui balloon, outcome measures, long-term follow up

f1 Correspondence: David Hildick-Smith, Cardiology Registrar, Cardiac Unit, Papworth Hospital, Cambridge CB3 8RE, U.K.

References

  1. Ben Farhat M, Ayari M, Maatouk F. Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. Circulation. 1998;97:245–250[Abstract/Free Full Text]
  2. Patel JJ, Shama D, Mitha AS. Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol. 1991;18:1318–1322[Abstract]
  3. Reyes VP, Raju BS, Wynne J. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Engl J Med. 1994;331:961–967[Abstract/Free Full Text]
  4. Turi ZG, Reyes VP, Raju BS. Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis. A prospective, randomized trial. Circulation. 1991;83:1179–1185[Abstract/Free Full Text]
  5. Arora R, Nair M, Kalra GS, Nigam M, Khalilullah M. Immediate and long-term results of balloon and surgical closed mitral valvotomy: a randomized comparative study. Am Heart J. 1993;125:1091–1094[CrossRef][Web of Science][Medline]
  6. Woroszylska M, Ruzyllo W, Konka M. Long term follow up after percutaneous mitral commissurotomy with the Inoue balloon-incidence of restenosis. J Heart Valve Dis. 1994;3:594–601[Medline]
  7. Chen CR, Cheng TO, Chen JY, Huang YG, Huang T, Zhang B. Long-term results of percutaneous balloon mitral valvuloplasty for mitral stenosis: a follow-up study to 11 years in 202 patients. Cathet Cardiovasc Diagn. 1998;43:132–139[CrossRef][Web of Science][Medline]
  8. Cohen DJ, Kuntz RE, Gordon SP. Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty. N Engl J Med. 1992;327:1329–1335[Abstract]
  9. Block PC, Palacios IF, Block EH, Tuzcu EM, Griffin B. Late (two-year) follow-up after percutaneous balloon mitral valvotomy. Am J Cardiol. 1992;69:537–541[CrossRef][Web of Science][Medline]
  10. Ruiz CE, Zhang HP, Gamra H, Allen JW, Lau FY. Late clinical and echocardiographic follow up after percutaneous balloon dilatation of the mitral valve. Br Heart J. 1994;71:454–458[Abstract/Free Full Text]
  11. Iung B, Cormier B, Ducimetiere P. Functional results 5 years after successful percutaneous mitral commissurotomy in a series of 528 patients and analysis of predictive factors. J Am Coll Cardiol. 1996;27:407–414[Abstract]
  12. Orrange SE, Kawanishi DT, Lopez BM, Curry SM, Rahimtoola SH. Actuarial outcome after catheter balloon commissurotomy in patients with mitral stenosis. Circulation. 1997;95:382–389[Abstract/Free Full Text]
  13. Meneveau N, Schiele F, Seronde MF. Predictors of event-free survival after percutaneous mitral commissurotomy. Heart. 1998;80:359–364[Abstract/Free Full Text]
  14. Lau KW, Ding ZP, Quek S, Kwok V, Hung JS. Long-term (36–63 month) clinical and echocardiographic follow-up after Inoue balloon mitral commissurotomy. Cathet Cardiovasc Diagn. 1998;43:33–38[CrossRef][Web of Science][Medline]
  15. Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988;60:299–308[Abstract/Free Full Text]
  16. Tuzcu EM, Block PC, Griffin BP, Newell JB, Palacios IF. Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 years and older. Circulation. 1992;85:963–971[Abstract/Free Full Text]
  17. Tuzcu EM, Block PC, Griffin B, Dinsmore R, Newell JB, Palacios IF. Percutaneous mitral balloon valvotomy in patients with calcific mitral stenosis: immediate and long-term outcome. J Am Coll Cardiol. 1994;23:1604–1609[Abstract]
  18. Post JR, Feldman T, Isner J, Herrmann HC. Inoue balloon mitral valvotomy in patients with severe valvular and subvalvular deformity. J Am Coll Cardiol. 1995;25:1129–1136[Abstract]
  19. Jang IK, Block PC, Newell JB, Tuzcu EM, Palacios IF. Percutaneous mitral balloon valvotomy for recurrent mitral stenosis after surgical commissurotomy. Am J Cardiol. 1995;75:601–605[CrossRef][Web of Science][Medline]
  20. Palacios IF, Tuzcu ME, Weyman AE, Newell JB, Block PC. Clinical follow-up of patients undergoing percutaneous mitral balloon valvotomy. Circulation. 1995;91:671–676[Abstract/Free Full Text]
  21. Zhang HP, Allen JW, Lau FY, Ruiz CE. Immediate and late outcome of percutaneous balloon mitral valvotomy in patients with significantly calcified valves. Am Heart J. 1995;129:501–506[CrossRef][Web of Science][Medline]
  22. Iung B, Cormier B, Farah B. Percutaneous mitral commissurotomy in the elderly. Eur Heart J. 1995;16:1092–1099[Abstract/Free Full Text]
  23. Sahn D, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072–1083[Abstract/Free Full Text]
  24. 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[Abstract]
  25. Hildick-Smith DJR, Shapiro LM. Balloon mitral valvuloplasty employing double transseptal puncture. Cathet Cardiovasc Diagn. 1998;45:33–36[CrossRef][Web of Science][Medline]
  26. Iung B, Cormier B, Ducimetiere P. Immediate results of percutaneous mitral commissurotomy. A predictive model on a series of 1514 patients. Circulation. 1996;94:2124–2130[Abstract/Free Full Text]
  27. Ludman PF, Hildick-Smith DJ, Harcombe AA, Shapiro LM. Transient ST-segment changes associated with mitral valvuloplasty using the Inoue balloon. Am J Cardiol. 1997;79:1704–1705[CrossRef][Web of Science][Medline]
  28. Vahanian A. Percutaneous mitral commissurotomy. Eur Heart J. 1996;17:1465–1469[Free Full Text]
  29. Lefevre T, Bonan R, Serra A. Percutaneous mitral valvuloplasty in surgical high risk patients. J Am Coll Cardiol. 1991;17:348–354[Abstract]
  30. Shapiro LM, Hassanein H, Crowley JJ. Mitral balloon valvuloplasty in patients >70 years of age with severe mitral stenosis. Am J Cardiol. 1995;75:633–636[CrossRef][Web of Science][Medline]
  31. Feldman T, Carroll JD, Isner JM. Effect of valve deformity on results and mitral regurgitation after Inoue balloon commissurotomy. Circulation. 1992;85:180–187[Abstract/Free Full Text]
  32. Dean LS, Mickel M, Bonan R. Four-year follow-up of patients undergoing percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry. J Am Coll Cardiol. 1996;28:1452–1457[Abstract]
  33. Pavlides GS, Nahhas GT, London J. Predictors of long-term event-free survival after percutaneous balloon mitral valvuloplasty. Am J Cardiol. 1997;79:1370–1374[CrossRef][Web of Science][Medline]
  34. Cannan CR, Nishimura RA, Reeder GS. Echocardiographic assessment of commissural calcium: a simple predictor of outcome after percutaneous mitral balloon valvotomy. J Am Coll Cardiol. 1997;29:175–180[Abstract]
  35. Sagie A, Schwammenthal E, Newell JB. Significant tricuspid regurgitation is a marker for adverse outcome in patients undergoing percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol. 1994;24:696–702[Abstract]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 HeartHome page
B D Prendergast, T R D Shaw, B Iung, A Vahanian, and D B Northridge
Contemporary criteria for the selection of patients for percutaneous balloon mitral valvuloplasty
Heart, May 1, 2002; 87(5): 401 - 404.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (5)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Hildick-Smith, D.J.R
Right arrow Articles by Shapiro, L.M
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hildick-Smith, D.J.R
Right arrow Articles by Shapiro, L.M
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?