Circulation, Vol 81, 1190-1197, Copyright © 1990 by American Heart Association
A Cequier, R Bonan, A Serra, I Dyrda, J Crepeau, M Dethy and D Waters
To assess the incidence and long-term evolution of left-to-right atrial
shunting (AS) after the performance of percutaneous mitral valvuloplasty
(PMV), venovenous indicator dilution curves and right heart oximetric
measurements were obtained in 68 consecutive patients before and after
successful PMV. The procedure increased the mitral valve area (p less than
0.0001) and decreased the mitral gradient (p less than 0.0001). No AS was
detected before PMV, but it was detected immediately after PMV. Oximetry
identified AS in 17 patients (25%), and dilution curves identified AS in an
additional 25 (total, 62%). The ratio of mean pulmonary to systemic blood
flow (Qp/Qs) was 1.31 +/- 0.2, and in six patients (9%), the ratio was 1.5
or greater. Among nine clinical, 20 hemodynamic, and six procedural
variables, stepwise logistic regression analysis selected the following as
independent predictors of AS: smaller increases in valve area (p = 0.01)
after PMV, absence of previous surgical commissurotomy (p = 0.02), mitral
valve calcification (p = 0.02), and smaller left atria (p = 0.06). Among
the 33 patients recatheterized at 6 months, oximetry had detected AS in 10,
and dilution curves detected AS in an additional nine (total, 58%)
immediately after PMV. At 6 months, AS had decreased or disappeared in 14
of these patients (74%), had increased in three (16%), and was unchanged in
two (10%). Overall, at 6 months, oximetry identified AS in three patients,
and dilution curves identified AS in an additional 13 (total, 48%). AS was
detected at 6 months in only three patients but was not detected
immediately after PMV. Although AS is very frequent immediately after PMV,
Qp/Qs is usually less than 1.5. The appearance of shunting correlates with
patient characteristics and with less improvement in valve area after PMV.
Atrial shunting usually persists at 6 months, but its severity almost
always decreases.
ARTICLES
Left-to-right atrial shunting after percutaneous mitral valvuloplasty. Incidence and long-term hemodynamic follow-up
Department of Medicine, Montreal Heart Institute, Quebec, Canada.
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