149 Decrease in left atrium volume after successful balloon mitral valvuloplasty: an echographic and hemodynamic study - 07/07/11
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Résumé |
Background |
L eft atrium (LA) remodeling has a crucial adverse impact on outcome and prognosis in mitral stenosis (MS). Few studies have reported the effect of balloon mitral valvuloplasty (BMV) on LA volume. The aim of this study was to assess the evolution of LA volume immediately and 1 month after successful BMV in patients in sinus rhythm .
Methods |
Thirty-three consecutive patients (70% women; age 31±8 years; range 19–45) with moderate to severe MS (mitral valve area 1.5cm2) who underwent successful BMV were included prospectively. Using two-dimensional echocardiography, and according to the prolate ellipse method, LA volume and LA volume indexed to body surface area were determined before BMV, 24 hours and 1 month after BMV. Pulmonary artery–right ventricular (PA-RV) gradients, reflecting pulmonary pressures, and pulmonary vascular resistance were measured.
Results |
Mitral valve area increased from 0.88±0.16 to 1.55±0.26cm2 (p<0.0001). Mean mitral valve gradient (MVG) decreased from 16±6 to 6±2mmHg (p<0.0001) immediately after BMV. Indexed LA volume fell from 56±14 to 48±12mL/m2 (p=0.0002) immediately after BMV and to 45±13mL/m2 at 1 month (p<0.0001). Only patients with a median LA volume 55mL/m2 before BMV had a significant reduction in LA volume (p=0.0001). Decrease in LA volume was correlated with decreases in PA–RV peak diastolic gradient (r=0.45, p=0.008) and MVG (r=0.35, p=0.04).
Conclusion |
In patients with MS in sinus rhythm, successful BMV results in an immediate decrease in LA volume. This reduction, maximal immediately after BMV, correlates with decreases in MVG and PA–RV peak diastolic gradient, and is significant only when LA volume before BMV is severely enlarged.
Change in indexed LA volume after BMV
Change in indexed LA volume after BMVLeft atrium variablesBefore BMVAfter BMV1 month after BMVp value (before vs after)p value (before vs at 1 monthVolume, mL77±2266±1862±180.0003<0.0001Indexed volume, mL/m256±1448±1245±130.0002<0.0001Anteroposterior diameter, mm44±541±540±6<0.0001<0.0001Inferosuperior diameter, mm67±666±665±60.50.07Mediolateral diameter, mm48±645±545±40.020.007Area, cm227±525±425±40.020.003
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Plan
Vol 3 - N° 1
P. 48-49 - janvier 2011 Retour au numéro
Article précédent
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- François Godart, Rachid Bouallal, Adelaïde Richard, Charles Francart
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- Fatima Wadrahmane, Roger Kongo Minga, Farah Korchi
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