Published online before print March 4, 2002, doi: 10.1161/01.CIR.0000012143.27196.F4
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(Circulation. 2002;105:1465.)
© 2002 American Heart Association, Inc.
Which Patients Benefit From Percutaneous Mitral Balloon Valvuloplasty?
Prevalvuloplasty and Postvalvuloplasty Variables That Predict Long-Term Outcome
From the Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Correspondence to Igor F. Palacios, MD, Cardiac Unit, Massachusetts General Hospital, Boston, MA 02114. E-mail palacios.igor{at}mgh.harvard.edu
Background— Percutaneous mitral balloon valvuloplasty (PMV) results in good immediate results, particularly in patients with echocardiographic scores (Echo-Sc) 
8. However, which variables relate to long-term outcome is unclear.
Methods and Results— We report the immediate and long-term clinical follow-up (mean, 4.2±3.7 years; range, 0.5 to 15) of 879 patients who underwent 939 PMV procedures. Patients were divided into 2 groups, Echo-Sc 8 (n=601) and Echo-Sc >8 (n=278). PMV resulted in an increase in mitral valve area from 1.0±0.3 to 2.0±0.6 cm2 in patients with Echo-Sc 8 and from 0.8±0.3 to 1.6±0.6 cm2 in patients with Echo-Sc >8 (P<0.0001). Although adverse events (death, mitral valve surgery, and redo PMV) were low within the first 5 years of follow-up, a progressive number of events occurred beyond this period. Nevertheless, survival (82% versus 57%) and event-free survival (38% versus 22%) at 12-year follow-up was greater in patients with Echo-Sc 8 (P<0.0001). Cox regression analysis identified post-PMV mitral regurgitation 
3+, Echo-Sc >8, age, prior surgical commissurotomy, NYHA functional class IV, pre-PMV mitral regurgitation 2+, and higher post-PMV pulmonary artery pressure as independent predictors of combined events at long-term follow-up.
Conclusions— The immediate and long-term outcome of patients undergoing PMV is multifactorial. The use of the Echo-Sc in conjunction with other clinical and morphological predictors of PMV outcome allows identification of patients who will obtain the best outcome from PMV.
Key Words: valvuloplasty • echocardiography • follow-up studies • mitral valve
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