Abstract 3553: Echocardiographic Mechanisms and Clinical Impact of Significant Mitral Regurgitation After Percutaneous Mitral Valvuloplasty
To assess the incidence and clinical impact of different mechanisms of significant traumatic mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV), echocardiographic and clinical follow-up data were analyzed in 380 patients (286 women, mean age 44 ± 11 years). Significant MR (≥3/4) developed in 47 patients (12.4%); commissural MR (group 1), MR originating at the site of successful commissurotomy, was shown in 27 patients (57%), and other mechanisms (group 2, non-commissural MR) included chordae rupture and flail motion in 12 (26%) and leaflet laceration only in 8 (17%). Immediately after PMV, the mitral valve area did not show any significant difference; however, mean mitral gradient was significantly lower in group 1 (6.3 ± 3.2 vs 8.8 ± 2.8 mmHg, p = 0.002). Clinical events (mitral valve replacement [MVR], death, and admission) occurred more frequently in patients with MR, and significantly higher event-free survival rate was observed in group 1 than in group 2. During clinical follow-up of 74 ± 29 months, MVR was done in 19 patients (40%), whereas the remaining 28 patients received medical treatment only. Group 1 showed significantly lower rate of MVR compared to group 2 (15% versus 70%, p<0.001). Muitivariate analysis showed that atrial fibrillation (OR=7.4, p=0.038), mean mitral gradient immediately after PMV (OR=1.5, p=0.009), and mechanism of MR (OR=16.7, p=0.005) were independent factors associated with MVR.
Conclusions Patients with significant MR after PMV show variable clinical course according to the echocardiographic mechanisms and those with commissural MR have more favorable prognosis.