Initial Results and Long-Term Follow-up of Percutaneous Mitral Valvuloplasty in Patients with Pulmonary Hypertension - 18/04/17

Doi : 10.1016/j.hlc.2016.04.026

Ricardo A. Sarmiento, MD, FACC ^a,^b, Rodrigo Blanco, MD ^a,^c, Gerardo Gigena, MD ^a, Jorge Lax, MD ^a, Alejandro Garcia Escudero, MD ^a,^c, Federico Blanco, MD ^a,^c, Jorge Szarfer, MD ^a, Raul Solerno, MD ^b, Carlos D. Tajer, MD, FACC ^b, Juan A. Gagliardi, MD, PhD ^a,^⁎
^a Sección Hemodinamia, División Cardiología. Hospital General de Agudos Dr. Cosme Argerich. Buenos Aires, Argentina
^b Hospital El Cruce de Alta Complejidad en Red Dr. Néstor Kirchner, Florencio Varela, Provincia de Buenos Aires, Argentina
^c Servicio de Hemodinamia. Cardiovascular Chivilcoy. Sanatorio Chivilcoy. Chivilcoy, Provincia de Buenos Aires, Argentina

^⁎Corresponding author at: Av. Alte. Brown 240 2 piso. (C1155ADP) Buenos Aires. Argentina, Tel.:-fax: +54-11-4121-0873

Résumé

Background

Percutaneous balloon mitral valvuloplasty (PMV) is an attractive therapeutic approach in patients with mitral stenosis. The aim of this study was to assess the immediate and long-term clinical, echocardiographic and haemodynamic outcomes of PMV in patients with severe pulmonary hypertension (PAH).

Methods

Percutaneous balloon mitral valvuloplasty was performed in 157 consecutive patients; 60 patients (38.2%) had significant PAH defined as baseline pulmonary artery mean pressure (PAMP) ≥ 30mm Hg (Group 1) and 97 patients (61.8%) had PAMP ≤ 30mmHg (Group 2).

Pulmonary artery systolic pressure (PASP), mortality, need for mitral valve replacement or new PMV, and valve restenosis were evaluated during follow-up.

Results

Mean age was 44.2 years and 88.5% (139 patients) were women. Primary success was achieved in 79.6% of the patients (125 patients) without differences between the groups.

Mitral valve area increased from 0.90cm² to 1.76cm², PASP fell from 57mmHg to 35mmHg in Group 1 and from 38mmHg to 30mmHg in Group 2.

Median PASP in Group 1 was 35, 32, 36, 38 and 34mmHg at 12, 24, 36, 48 and 60 months. There were no significant differences in mitral valve area, PASP and clinical status between the groups.

Conclusion

Percutaneous balloon mitral valvuloplasty is a safe and effective technique for the treatment of patients with mitral stenosis and PAH. A significant decrease in pulmonary pressure was observed after valvuloplasty. Although there was a gradual decrease of MVA at long-term follow-up, most patients remained asymptomatic and PASP was stable.

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Keywords : Valvuloplasty, Mitral valve stenosis, Haemodynamics, Pulmonary hypertension

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Vol 26 - N° 1

P. 58-63 - janvier 2017 Retour au numéro

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Initial Results and Long-Term Follow-up of Percutaneous Mitral Valvuloplasty in Patients with Pulmonary Hypertension - 18/04/17

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