Influence of Mitral Valve Morphology on Double - Balloon Catheter Balloon Valvuloplasty in Patients With Mitral Stenosis

To determine if mitral valve morphology influences the results of double-balloon catheter balloon valvuloplasty (CBV) for mitral stenosis, two-dimensional echocardiography was performed in 33 patients before CBV. The two-dimensional echocardiographic features of leaflet motion, leaflet thickness, subvalvular disease, and commissural calcium and 14 pre-CBV clinical and hemodynamic variables were then correlated to the immediately post-CBV mitral valve area (MVA). At 3 months after CBV, the two-dimensional echocardiographic features of patients with a 25% or greater decrease in MVA were analyzed to determine whether mitral valve morphology had influenced early results. Leaflet motion had a significant relation with the immediately post-CBR MVA (r=0.67, y=4.5x+0.29, and SEE=0.45). Leaflet thickness had a weak and negative relation (r= -0.48, y= -0.17x+ 2.6, and SEE= 0.53) with the immediately post-CBR MVA. Subvalvular disease and commissural calcium had no significant relation to the immediately post-CBV MVA. When leaflet motion and leaflet thickness were considered as grades of mild, moderate, and severe and assigned a score of 0-2, patients with more severe disease (total score, 3 or 4) had a significantly lower MVA immediately after CBV (1.4+±0.4 cm2) than patients with moderate disease (score, 1-2; MVA, 2.0+0.5 cm2; p<0.05) or mild disease (score, 0; MYA, 2.6+±0.6 cm2; p<0.05). In 96% of patients with a total score of 0-2, the immediately post-CBV MVA was more than 1.4 cm2, whereas only 29% of patients with a total score of 3-4 had an immediately post-CBV MVA of more than 1.4 cm2. Analysis of all two-dimensional echocardiographic features showed that leaflet motion score had the strongest influence on the post-CBV MVA (p<0.001). When all two-dimensional echocardiographic, clinical, and hemodynamic variables were included, leaflet motion, effective balloon dilating area, and cardiac output were the strongest predictors of the immediate post-CBV MYA. No two-dimensional echocardiographic feature predicted patients with an early reduction in MYA at 3 months after CBV. Quantitative assessment of leaflet motion and leaflet thickness by two-dimensional echocardiography is helpful in understanding and predicting the immediate results of double-balloon CBV of mitral stenosis; pre-CBV measurement of leaflet motion and the effective balloon dilating area used in the procedure are the strongest predictors of the MVA obtained by double-balloon CBV. (Circulation 1989;80:515-524)