Circulation, Vol 82, 448-456, Copyright © 1990 by American Heart Association
VM Abascal, GT Wilkins, JP O'Shea, CY Choong, IF Palacios, JD Thomas, E Rosas, JB Newell, PC Block and AE Weyman
We studied 130 patients undergoing percutaneous balloon mitral valvotomy.
The relation between valvular morphology according to a previously
described echocardiographic scoring system and hemodynamic outcome
expressed as qualitative ("good" and suboptimal) and as absolute change in
valve area was analyzed. The relative importance of the individual
components of this echocardiographic score (valvular thickening, mobility,
calcification, and subvalvular disease) to the change in valve area after
valvotomy was also examined. Mean transmitral pressure gradient decreased
from 16 +/- 6 to 6 +/- 3 mm Hg (p less than 0.0001), and mitral valve area
increased from 0.9 +/- 0.3 to 1.8 +/- 0.7 cm2 (p less than 0.0001). Results
in individual patients were variable. Eighty-four percent (61 of 73) of
patients with an echocardiographic score of 8 or less had a "good" outcome
(final valve area greater than or equal to 1.5 cm2 and an increase in valve
area of greater than or equal to 25%), whereas 58% (33 of 57) of patients
with an echocardiographic score of 8 or more had a suboptimal result (p
less than 0.001). The sensitivity of an echocardiographic score of 8 or
less for predicting a "good" outcome was 72%, and the specificity was 73%.
The echocardiographic score correlated negatively (r = -0.40, p less than
0.0001) with the absolute increase in mitral valve area after valvotomy,
but there was substantial scatter in the data. Of the four components of
the total echocardiographic score, valvular thickening correlated best with
the absolute change in value area (r = -0.47, p less than 0.0001).(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy
Department of Medicine, Massachusetts General Hospital, Boston 02114.
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