Circulation, Vol 85, 963-971, Copyright © 1992 by American Heart Association
EM Tuzcu, PC Block, BP Griffin, JB Newell and IF Palacios
BACKGROUND. We analyzed the immediate and long-term outcome of percutaneous
balloon mitral valvotomy (PMV) in 99 patients who were greater than or
equal to 65 years of age (81 women and 18 men; mean +/- SEM age, 72 +/- 0.5
years). METHODS AND RESULTS. There were 84 patients in New York Heart
Association (NYHA) class III or IV; 26 patients had previous surgical
commissurotomy; 64 had one or more comorbidities; 73 had fluoroscopically
visible mitral valve (MV) calcification; and 63 had echocardiographic score
greater than 8 (mean +/- SEM score, 9.2 +/- 0.2). There were three
procedural deaths, all occurring in our early experience. Pericardial
tamponade occurred in five patients, thromboembolism in three, and
transient atrioventricular block in one. After PMV, MV area was greater
than or equal to 1 cm2 in 86 patients and greater than or equal to 1.5 cm2
in 56. A successful outcome (defined as MV area greater than or equal to
1.5 cm2 without a greater than or equal to 2-grade increase in mitral
regurgitation and without left-to-right shunt with a pulmonary-to-systemic
flow ratio of greater than or equal to 1.5:1) was achieved in 46 patients.
The best multivariate predictor of success was the combination of
echocardiographic score, NYHA functional class, and inverse of MV area.
Mean follow-up was 16 +/- 1 months. Actuarial survival (79 +/- 7% versus 62
+/- 10%, p = 0.04), survival without MV replacement (71 +/- 8% versus 41
+/- 8%, p = 0.002), and survival without MV replacement and NYHA class III
or IV (54 +/- 12% versus 38 +/- 8%, p = 0.01) at 3 years were significantly
better in the successful group of 46 patients than in the unsuccessful
group of 53 patients. Low echocardiographic score was the only independent
predictor of survival. Lack of MV calcification and low NYHA class, low
mean left atrial pressure, and low pulmonary artery pressure were the
independent predictors of event- free survival. CONCLUSIONS. PMV can be
performed safely in selected patients greater than or equal to 65 years old
with good immediate and long-term results. In addition to clinical
examination, echocardiographic evaluation of the mitral valve and
fluoroscopic screening for valvular calcification are the most important
steps in patient selection for successful outcome.
ARTICLES
Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 years and older
Department of Medicine (Cardiac Unit), Massachusetts General Hospital, Harvard Medical School, Boston 02114.
This article has been cited by other articles:
 |
|
 |
|
  2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]
|
|
|
|
 |
|
 A. D. Zimmet, A. A. Almeida, R. W. Harper, J. J. Smolich, J. Goldstein, G. C. Shardey, and J. A. Smith Predictors of surgery after percutaneous mitral valvuloplasty. Ann. Thorac. Surg., September 1, 2006; 82(3): 828 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
 |
|
 N Sutaria, T R D Shaw, B Prendergast, and D Northridge Transoesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy Heart, January 1, 2006; 92(1): 52 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
A. Vahanian VALVE DISEASE: Balloon valvuloplasty Heart, February 1, 2001; 85(2): 223 - 228. [Full Text]
|
|
|
|
 |
|
 D.J.R Hildick-Smith, G.J Taylor, and L.M Shapiro Inoue balloon mitral valvuloplasty: long-term clinical and echocardiographic follow-up of a predominantly unfavourable population Eur. Heart J., October 2, 2000; 21(20): 1690 - 1697. [Abstract] [PDF]
|
|
|
|
|
|
D J R HILDICK-SMITH and L M SHAPIRO Balloon mitral valvuloplasty in the elderly Heart, April 1, 2000; 83(4): 374 - 375. [Full Text]
|
|
|
|
|
|
R. O. Bonow Valvular heart disease J. Am. Coll. Cardiol., April 1, 2000; 35(5_Suppl_B): 32B - 34B. [PDF]
|
|
|
|
|
|
D.-H. Kang, S.-W. Park, J.-K. Song, H.-S. Kim, M.-K. Hong, J.-J. Kim, and S.-J. Park Long-term clinical and echocardiographic outcome of percutaneous mitral valvuloplasty: Randomized comparison of Inoue and double-balloon techniques J. Am. Coll. Cardiol., January 1, 2000; 35(1): 169 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. N. Leon, L. C. Harrell, H. F. Simosa, N. A. Mahdi, A. Pathan, J. Lopez-Cuellar, I. Inglessis, P. R. Moreno, and I. F. Palacios Mitral balloon valvotomy for patients with mitral stenosis in atrial fibrillation: Immediate and long-term results J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1145 - 1152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow Valvular heart disease J. Am. Coll. Cardiol., August 1, 1999; 34(2): 315 - 317. [Full Text] [PDF]
|
|
|
|
|
|
A. Z. Pathan, N. A. Mahdi, M. N. Leon, J. Lopez-Cuellar, H. Simosa, P. C. Block, L. Harrell, and I. F. Palacios Is redo percutaneous mitral balloon valvuloplasty (PMV) indicated in patients with post-PMV mitral restenosis? J. Am. Coll. Cardiol., July 1, 1999; 34(1): 49 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. F. Palacios Farewell to Surgical Mitral Commissurotomy for Many Patients Circulation, January 27, 1998; 97(3): 223 - 226. [Full Text] [PDF]
|
|
|
|
|
|
B. Iung, B. Cormier, P. Ducimetiere, J.-M. Porte, O. Nallet, P.-L. Michel, J. Acar, and A. Vahanian Immediate Results of Percutaneous Mitral Commissurotomy: A Predictive Model on a Series of 1514 Patients Circulation, November 1, 1996; 94(9): 2124 - 2130. [Abstract] [Full Text]
|
|
|
|
|
|
I. F. Palacios, M. E. Tuzcu, A. E. Weyman, J. B. Newell, and P. C. Block Clinical Follow-up of Patients Undergoing Percutaneous Mitral Balloon Valvotomy Circulation, February 1, 1995; 91(3): 671 - 676. [Abstract] [Full Text]
|
|
|
|
 |
|
 V. P. Reyes, B. S. Raju, J. Wynne, L. W. Stephenson, R. Raju, B. S. Fromm, P. Rajagopal, P. Mehta, S. Singh, D. P. Rao, et al. Percutaneous Balloon Valvuloplasty Compared with Open Surgical Commissurotomy for Mitral Stenosis N. Engl. J. Med., October 13, 1994; 331(15): 961 - 967. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. D. Carroll and T. Feldman Percutaneous Mitral Balloon Valvotomy and the New Demographics of Mitral Stenosis JAMA, October 13, 1993; 270(14): 1731 - 1736. [Abstract] [PDF]
|
|
|
|
|
|
I. F. Palacios, P. L. Sanchez, L. C. Harrell, A. E. Weyman, and P. C. Block Which Patients Benefit From Percutaneous Mitral Balloon Valvuloplasty?: Prevalvuloplasty and Postvalvuloplasty Variables That Predict Long-Term Outcome Circulation, March 26, 2002; 105(12): 1465 - 1471. [Abstract] [Full Text] [PDF]
|
|