Percutaneous Transvenous Mitral Balloon Valvuloplasty Alone in Patients with Combined Aortic and Mitral Stenosis

Abstract

To investigate the feasibility of percutaneous transvenous balloon dilatation of the mitral valve in patients with combined aortic and mitral stenosis, 12 patients were studied by echocardiography and catheterization before and after mitral valvuloplasty. Aortic stenosis was defined from prevalvuloplasty catheterization study as a transaortic pressure gradient of more than 25 mm Hg. All 12 patients underwent transvenous balloon mitral valvuloplasty successfully. Immediately after the procedure, all patients experienced improvement in clinical symptoms and in hemodynamic variables. Mitral valve areas were significantly increased from 0.78 ±0.18 to 1.73 ±0.21 cm² (P<0.0001) by planimetry method. Cardiac output was significantly increased from 3.6 ±0.1 to 4.2 ±0.5 L/min (P=0.01). Mean transaortic flow rate increased 33% (from 198 ±68 to 254 ±41 mL/s, P=0.002). Mean pressure gradient across the aortic valve after mitral valvulo plasty was not significantly increased, from 34 ±7 to 37 ±13 mm Hg. Aortic valve areas, derived from the Gorlin formula, were significantly increased from 0.57 ±0.12 to 0.73 ±0.14 cm² (P=0.006) after mitral valvuloplasty. However, continuity equation-derived aortic valve area was independent of increasing flow rate after mitral valvuloplasty from 1.29 ±0.35 to 1.30 ±0.29 cm². During follow-up with a mean of twenty four ±fourteen months, 8 patients were in New York Heart association functional class I, 3 in class II, and 1 in class IV who received pericardiotomy owing to constrictive pericarditis without aortic valve replacement. In conclusion, mitral valvuloplasty alone may be safe and effective in alleviating symptoms in mitral stenosis patients with transaortic pressure gradient >25 mm Hg. Continuity equation-derived aortic valve areas seem to be flow independent in evaluation of aortic stenosis and are important for decision making.