CHANGES OF PLASMA ENDOTHELIN CONCENTRATIONS BEFORE AND AFTER PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY IN PATIENTS WITH MITRAL STENOSIS

Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty(PBMV). The basal plasma concentrations of endothelin in blood from the antecubirtal vein in the patients were significantly higher than those in 32 control subjects (15. 40± 3. 32 vs. 9. 59± 2. 66 pg/ml, P<0. 001). Plasma endothelin concentrations in patients in New York Heart Association functional classes Ⅱ and Ⅲ were significantly higher than those in control subjects, respectively. The concentrations of endothelin in patients with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm. Ten to fifteen minutes after PBMV, plasma endothelin concentrations in blood from the femoral vein significantly decreased from 16. 14 ± 3. 34 to 13. 74 ± 3. 78 pg/ml (P<0. 01 ). Seventy-two hours after the procedure, the concentrations of endothelin in blood from the antecubital vein had fallen to 12. 31 ± 2. 55 pg/ml (P<0. 001 vs. before PBMV and control subjects). Plasma endothelin concentrations still tended to be higher in patients with atrial fibrillation than those in normal sinus rhythm, but the difference did not reach statistical significance. There were weak but significantly correlations of plasma endothe lin concentrations with the mean left atrial pressure (r= 0. 424 , P < 0.001 ), mean right atrial pressure (r=0. 323, P<0. 01), mean transmitral pressure gradient (r= 0. 397, P<0. 001), heart rate (r= 0. 350,P<0. 005)and mitral valve area (r=-0. 454, P<0. 001) in the patients before and after PBMV.

CHANGES OF PLASMA DYNORPHIN LEVELS BEFORE AND AFTER PERCUTANEOUS BALLOON MITRAL COMMISSUROTOMY IN PATIENTS WITH MITRAL STENOSIS

Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood from the antecubital vein in the patients were significantly higher than those in 31 healthy control subjects. The increase in circulating dynorphin closely correlated with the functional cardiac status and the presence of atrial fibrillation. Ten to fifteen minutes after PBMC, plasma dynorphin levels in blood from the femoral vein increased significantly. Seventy-two hours after the procedure, the levels of plasma dynorphin in blood from the antecubital vein had decreased significantly , but they did not decrease to the normal range. Plasma dynorphin levels in blood from the femoral vein were positively correlated with the mean left atrial pressure and the mean right atrial pressure before the first balloon inflation. Plasma dynorphin levels in blood from the antecubital vein were positively correlated with the heart rate and the mean transmitral pressure gradient, and negatively with the mitral valve area before and 72 hours after PBMC.

Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background： Tricuspid regurgitation （TR） is frequently associated with severe mitral stenosis （MS）, the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty （PBMV） procedure in rheumatic heart disease patients with mitral valve （MV） stenosis and tricuspid valve regurgitation. Methods： Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV： MV area （MVA）, TR area （TRA）, atrial pressure and diameter, and pulmonary artery pressure （PAP）. The patients were followed for 6 months to 9 years. Results： After PBMV, the MVAs increased significantly （1.7 ± 0.3 cm2 vs. 0.9 ± 0.3 cm2, P 〈 0.01）; TRA significantly decreased （6.3 ± 1.7 cm2 vs. 14.2 ± 6.5 cm2, P 〈 0.01）, right atrial area （RAA） decreased significantly （21,5 ± 4.5 cm2 vs. 25.4 ± 4.3 cm〈 P 〈 0.05）, TRA/RAA （%） decreased significantly （29.3 ± 3.2% vs. 44.2 ± 3.6%, P 〈 0.01）. TR velocity （TRV） and TR continue time （TRT） as well as TRV - TRT decreased significantly （ 183.4± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P 〈 0.01 ; 185.7 ± 13.6 ms vs. 238.6 ±l 1.3 ms, P 〈 0.01 ; 34.2 ±5.6 cm vs. 60.7 ± 8.5 cm, P 〈 0.01, respectively）, The postoperative left atrial diameter （LAD） significantly reduced （41.3 ± 6.2 mm vs. 49.8± 6.8 mm, P 〈 0.01） and the postoperative right atrial diameter （RAD） significantly reduced （28.7 ±5.6 mm vs. 46.5 ± 6.3 mm, P 〈 0.01 ）; the postoperative left atrium pressure significantly reduced （ 15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P 〈 0.01 ）, the postoperative right atrial pressure decreased significantly （ 13.2 ±2.4 mmHg vs. 18.5 ±4.3 mmHg, P 〈 0.01 ）. The pulmonary arterial pressure decreased significantly after PBMV （48.2 ± 10.3 mmHg vs. 60.6 ±15.5 mmHg, P 〈 0.01）. The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years （average 75± 32 months）, 2 patients with severe regurgitation died （1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively）, 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative （1.4 ± 0.4 cm2 vs. 1.7 ±0.3 cm2, P 〈 0.05）; LAD slightly increased compared with the postoperative （45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P 〈 0.05）, RAD slightly also increased compared with the postoperative （36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P 〈 0.05）, but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant （P 〉 0.05）. The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative （P 〉 0.05）, the remaining patients without serious complications. Conclusions： PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.

Echocardiographic and Clinical Evaluation of Rheumatic Mitral Stenosis in Younger and Elderly Patients

Background: Rheumatic heart disease (RHD) is common form of heart disease among population, especially in developing countries like India. Mitral stenosis (MS) is majorly caused by rheumatic heart disease with mitral commissural adhesion, fibrosis and calcification of the chordae tendineae. The aim of present study was clinical and echocardiographic evaluation for mitral stenosis in RHD patients with different age group. Methods: This was a retrospective, nonrandomized, and single-centre study in which 203 consecutive patients presented rheumatic mitral stenosis. All the patients were divided into different age group viz. 65 years. Cardiovascular examination and echocardiography were done in each patient. Mitral valve area (MVA), mitral valve gradient (MVG) and left atrial (LA) diameter were assessed by echocardiography. Mitral valve score was recorded to analyse the degenerative changes in mitral valve structure. Results: A total of 203 patients (133 females) were enrolled and divided into three age groups. Patients with age above 65 years were considered as elderly and those patients with age below 40 years were considered as younger. Echocardiographic assessment showed mean 4.7 and 4.9 cm LA diameter, 0.92 and 0.86 cm2 MVA and 11.2 and 9.7 mm Hg MVG in younger and elderly patients respectively. Total mitral valve score has shown significant (p 2 had shown significant difference (p Conclusion: Present study provides unique contemporary data on characteristics and management of patients with rheumatic mitral stenosis. Majority of elderly patients are unsuitable for percutaneous commissurotomy due to degenerative changes in mitral valve structure.

PBMV IN TREATING MITRAL STENOSIS WITH LEFT ATRIAL THROMBUS

We have performed 348 canes of PBMV(pereutsneous Balloon Mitralvalvhloplssty)since April 1989,in which there are 4 Patients(13.8%)diagnosed as mitral stenosis with left atrial thrombus.To keepprothrombin time 1.5-2 times as normal,two kiods of thrombolytictherapy was qiven to these 48 patients,one was using 2 weeks ofurokinase(20 theusand units/d intravaneously)for early 18 cases,theother was using 4 weeks of warlarin(3-10mg/d.po)for other 30cases.PBMV was perlormed after thrombolytic therapy.In those 48cases,PBMV of 47 cases were successful,none of them had thecomplication,such as cerebral,limb and systemic emboesm.Though 1ease of PBMV was failed because balloon couldn’t be sent to mitralorifice owing to thrombus just adjacent to mitral orifice,which wasverified by intraesophagesl echocardiogram after operation,butseveral times of touching between balloon and thrombus hadn’tresulted in other organ’s embolism.Above data revealled that it’s safeto take PBMV after 4 weeks of thrombolytic therapy of warfarin inpatients of mitral stenosis with left atrial thrombus.The mechanismperhaps is,we think,that thrombolylic therapy can make freshthrombua dissolute and make old ones organize to prevent thrombusfrom dropping.So the patients of mitral stenosis with left atrialthrombus can take PBMV after strict thrombolytic therapy.

Predictors of Complications during Percutaneous Multitrack Balloon Mitral Valvuloplasty

Background: Percutaneous mitral balloon valvuloplasty is the main procedure in mitral stenosis (MS). It can replace surgical commissurotomy in many cases;however, mitral regurgitation (MR) remains the major procedure complication. Objectives: This study was conducted to investigate predictors of MR as a complication followingpercutaneous mitral valvuloplasty (PMV) using multitrack balloon technique. Methods: This cohort study was conducted at both Menoufia University Hospital and Mabaret Misr Elkadima Hospital. We enrolled 121 patients with moderate to severe MS who were subjected to PMV using multitrack balloon technique during the period from October 2017 to October 2019. Transthoracic echocardiographic evaluation was performed for all patients before and after the procedure. Patients who developed severe MR post procedure were compared with other patients to identify important distinction points. Results: Most patients (N = 109, 90.1%) developed no/mild MR (group A), whereas 12 (9.9%) patients developed severe MR (group B) after PMV. Those who developed severe MR had significantly higher weight, height, body mass index, and body surface area (P value < 0.001 for each). Also, there was a significant difference between both groups regarding pre-operative Wilkins score (8.7 ± 1.3 for severe MR versus 7.9 ± 1.2 for No/Mild MR, P = 0.046). Patients who developed severe MR had higher incidence of other valvular lesions such as mild aortic regurgitation (91.7% versus 36.7%, P < 0.001), higher mitral valve (MV) commissural calcification (50.0% versus 14.7%, P = 0.008), pre-operative MR (100.0% versus 35.8%, P < 0.001), higher prevalence of atrial fibrillation (100.0% versus 38.5%, P < 0.001). Regarding balloon sizing, it was significantly higher among patients who developed severe MR compared with those having mild or no MR (P = 0.001). Multivariate regression analysis identified MV balloon sizing (OR 3.877, CI 95% 1.131 - 13.289, P = 0.031) and MV commissural asymmetry of calcification (OR 67.48, CI 95% 5.759 - 790.72, P = 0.001) as significant predictors of outcomes of MV commissurotomy. Conclusion: Mitral valve calcification, balloon sizing, and MV asymmetry are significant factors that can predict the development of MR after balloon valvuloplasty.

Clinical outcome of percutaneous balloon mitral valvuloplasty in 103 patients

Percutaneous balloon mitral valvuloplasty (PBMV) was performed in 103 consecutive patients with rheumatic mitral stenosis. PBMV was accomplished in 99 patients. Singnificant symptomatic improvement was achieved in 98 patients (98/99 , 99% ). Mean left atr

The Value of Perioperative Echocardiography in Percutaneous Balloon Mitral Valvuloplasty

in order to investigate the value of perioperative echocardiography in percutaneous balloon mitral valvuloplasty (PBMV),two-dimensional echocardiography (2-DE), Doppler echocardiography and color Doppler flow imaging (CDFI) were employed prior to PBMV in 52 patients and during or after PBMV in 15 patients. The results showed that TTE and TEE were helpful in the selection of candidates for 2-DE transseptal and balloon dilation procedures. Continuous monitoring of 2-DE, Doppler echocardiography and CDFI during PBMV could make this procedure safer and more effective, reduce X-ray exposure and avoid complications. Echocardiography was usefui in fluoroscopy and could be used for evaluation of the effects of operation.

IMPORTANCE OF ATRIAL CONTRIBUTION TO LEFT VENTRICULAR FILING IN MITRAL STENOSIS BEFORE AND AFTER BALLOON VALVULOPLASTY

To assess the importance of atrial contribution to left ventricular filling in mitral stenosis, Doppler echocardiography war performed in 31 patients with mitral stenosis and sinus rhythm before(all patients) and after (15 patients) percutaneous mitral balloon valvuloplasty. Percent atrial contribution was derived from the ratio of atrial velocity-time integral (VTI) to total mitral VTL.The percent atrial contribution correlated closely with mitral valve area (r=0.91, P<0.001) and was inversely related to mean pressure gradient across the mitral valve orifice (r= -0.68, P<0.01). The study indicates that the degree of mitral stenosis exeris a great effect on the importance of a trial contribution to left ventricular filling in patients with mitral stenosis and sinus rhythm.

Assessment of mitral valve reserve capacity before and after percutaneous balloon valvuloplasty with isoproterenol stress echocardiography

Objective: To explore whether successful valvuloplasty increases mitral valve reserve capacity in patients with mitral stenosis. Methods: Thirty-eight patients with pure rheumatic mitral stenosis underwent isoproterenol stress echocardiography before and after successful percutaneous balloon valvuloplasty. The mitral valve area (by direct planimetry of two-dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M-mode echocardiography) were measured at rest and under isoproterenol infusion to achieve heart rate of different stages. Results:Between the measurements before and after valvuloplasty, significant differences were observed in the mitral valve area (0. 91±0. 28 vs 1. 87±0. 23 cm2, P<0. 01), mean transmitral pressure gradient (12. 5±6. 3 vs 3. 9±1. 9 mmHg, P<0. 01) and cardiac output (3. 93±1. 44 vs 4. 73±1. 01 L/min, P<0. 05) at rest. Before valvuloplasty, the mean transmitral pressure gradient increased significantly (P<0. 01) as heart rate increased, but there were no significant differences in the measurements of mitral valve area and cardiac output (both P>0. 05). In contrast, there was a significant increase after valvuloplasty in the mean transmitral pressure gradient (P<0. 01), but both mitral valve area and cardiac output further increased (both P< 0. 01) as heart rate increased. Moreover, valvuloplasty decreased the mean transmitral pressure gradient at peak heart rate from 23. 0±4. 5 to 7. 75±2. 30 mmHg (F<0. 01) under submaximal stress. Conclusion: Successful percutaneous balloon valvuloplasty soon causes a significant increase of mitral valve reserve capacity in patients with mitral stenosis, which is conspicuously manifested under condition of hemodynamic stress. Stress echocardiography provides a safe, feasible and non-invasive means of assessing the reserve capacity.

Outcomes of balloon mitral valvuloplasty for rheumatic mitral stenosis during pregnancy

Background Rheumatic mitral stenosis is the most common acquired valvular heart disease encountered during pregnancy. Balloon mitral valvuloplasty(BMV)is one of the treatment options if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. Prospective studies on BMV and its effect on pregnancy outcomes and neonates are needed. Methods All pregnant women with severe symptomatic isolated mitral stenosis who underwent elective BMV in our institute from January 2000 to December 2018 were analyzed retrospectively. Clinical,haemodynamic and echocardiographic outcomes immediately after the procedure were analyzed. Results This study involved twenty-seven pregnant women in whom BMV was performed. The procedure was successful in 26 patients(96.29%). There were significant changes after BMV in the measured 2 D MVA,pulmonary arterial systolic pressure and the mean left atrial pressure(P<0.01). Post-procedure follow-up showed an improvement in NYHA status by at least one class in 85.19%(25/27)patients. In the cases of mitral valve regurgitation,the area of mitral valve regurgitation increased significantly after the procedure(P<0.01). Four(19.05%)patients had a full-term normal vaginal delivery and seventeen(80.95%)underwent cesarean section for obstetric indications. Five patients had abortions after the procedure. After the procedure,only one patient had severe mitral regurgitation after the procedure and nine patients had moderate mitral regurgitation,and the rest had either no mitral regurgitation or mild mitral regurgitation. Symptomatic improvement was noted in all of the patients with on maternal and fetal complications except one case of mortality. Conclusion Percutaneous BMV is safe and effective in providing excellent symptomatic relief and hemodynamic improvement for pregnant patients with mitral stenosis.[S Chin J Cardiol 2019;20(2):63-68]

PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY:EXPRIENCE OF 182 CASES

Objective:To evaluate the clinical results of pcrcutancous balloon mitratvalvuloplasty(PBMV)in patient with rheumatic nlitral stenosis.Materials andMethods:one hundred and eighty-two patients with rheumatic mitral stenosis(MS)have been Irented by PBMV since 1995.There were 30 males and 152females,aged 38.6+8.0 years.Atrial fibrillation occurred in 42 paticnts andsinus rhythm in 140 patients,including 18 patients wilh restenosis closedcommissurotomy and 8 patients with thrombus in the left atrial appendage bylaking a small dose of Warfarin(3mg/d)for 4-6 months.63 patients hadminimal mitral regurgitation,26 patients had minimal aortic valve stenosis onregurgitation.The balloon diameter was from 25mm to 28mm.PBMV wasperformed using tbe single balloon Inoue technique.Results:PBMV for 179 patients with MS were successfully performde AfienPBMV the mean Ien atrial pressure decreased from 36+11 mmllg to 12+4mmHg(P【0.001),the mean mitral value gradie(MVG)decreased from 32+6 mmHg to 9+5mmHg(P【0.001).the mean mitral valoe area incrensed from0.89±0.32 cm^2 lo 1.92±0.43 cm^2(P【0.001)the mean pulinonary arterypressure dropped from 54±26 mmHg to 32±14 mmHg(P【0.001).the mcanIen atrial diameler decreased(LAD) from 48 mm to 43 mm(P【0.001).symptomatic improvement occurred in 178 patients with severecolnplicatins.including one palient wilh.severe regurgitation of mitral valvedue to valve lear.another potienl with acute endovarditis there were no deatlor thronlhoembolic complications in all paticnts.Conclusion:The results suggest that PBMV is effective therapy for thepatients with mitral stenosis,the method is also of first choice for thealing MSwith cxcellent results,the procedure is very safely with high success rele and afew complications.

Isoproterenol Stress Echocardiography in Assessing Mitral Valve Area Reserve before and after Percutaneous Balloon Valvuloplasty

Objective To determinewhether successful valvuloplasty causes an increase of mitral valve area reserve in patients with mitral stenosis, isoproterenol stress echocardiography was used to compare mitral valve area and hemodynamic changes between pre - and post - valvuloplasty under conditions of increased cardiac work. Methods Thirty-eight patients with pure rheumatic mitral stenosis who had received successful percutaneous balloon valvuloplasty underwent isoproterenol stress echocardiography pre- and post - valvuloplasty. Mitral valve area (by direct planimetry of two - dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M-mode echocardiography) were measured at rest and under isoproterenol stress to achieve heart rate of different stages. Results Mitral valve area (0.91±0.28 to 1.87±0.23 cm2, P<0. 01), mean transmitral pressure gradient (12. 5±6. 3 to 3. 9± 1. 9 mmHg, P < 0. 01) and cardiac output (3. 93± 1. 44 to 4. 73±1. 01 L/min, P < 0. 05) at rest between pre - and post - valvuloplasty were significantly different. Pre - valvuloplasty, as heart rate increased under stress, mean transmitral pressure gradient increased significantly ( P < 0. 01), but there were no significant differences in the measurements of mitral valve area and cardiac output (both P>0. 05) . In contrast, as heart rate increased post-valvuloplasty, there was a significant increase in mean transmitral pressure gradient (P<0.01), but both mitral valve area and cardiac output further increased significantly (bothP<0. 01) . Moreover, valvuloplasty decreased mean transmitral pressure gradient at peak heart rate from 23. 0±4. 5 to 7. 75 ± 2. 30 mmHg ( P < 0. 01) under submaximal stress. Conclusions Successful percutaneous balloon valvuloplasty soon causes a significant increase of mitral valve area reserve in patients with mitral stenosis, which is markedly manifested under conditions of hemodynamic stress. Stress echocardiog-raphy provides a safe, feasible and non-invasive means of assessing this reserve capacity.

CHANGES OF PLASMA BETA-ENDORPHIN LEVELS BEFORE AND AFTER PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH MITRAL STENOSIS

To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta endorphin levels and hemodynamic changes in 35 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, plasma beta-endorphin levels obtained from the antecubital vein (28.91 ± 5.59 pg / ml) and from the femoral vein (28.20 ± 5.44 pg / ml) in the patients with mitral stenosis were significantly higher than those obtained from the antecubital vein in the healthy volunteers (22.59 ± 3.86 pg / ml, n = 34, P< 0.001 for each). The levels of beta-endorphin in the femoral vein correlated well with the mean left atrial pressure (r=0.777, P< 0.001) and the mean right atrial pressure (r = 0.450, P<0.01) before the procedure. The antecubital venous levels of beta-endorphin in patients in New York Heart Association functional Classess Ⅱ (26.45 ± 5.39 pg / ml, n = 20) and Ⅲ (32.20 ± 4.02 pg / ml, n = 15) were significantly higher than those in control subjects (P< 0.005 and P< 0.001, respectively). The differences between Classes Ⅱ and Ⅲ were significant (P < 0.001). The plasma levels of beta-endorphin in the patients complicated with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm (33.31 ± 3.22 pg / ml, n= 13 vs 26.32± 5.07 pg / ml, n = 22, P< 0.001). In ten to fifteen minutes after commissurotomy, plasma levels of beta-endorphin in the femoral vein significantly increased from 28.20 ± 5.44 to 33.14 ± 5.72 pg / ml (P< 0.001). In seventy-two hours after the procedure, plasma beta-endorphin levels in the antecubital vein fell to 24.37 ± 2.59 pg / ml (P< 0.001 vs before PTMC and P<0.05 vs control subjects). Plasma beta-endorphin levels in the patients with atrial fibrillation (26.62 ± 2.36 pg / ml, P< 0.001 vs before PTMC and P< 0.002 vs control subjects) were still higher (P< 0.001) than those in patients with normal shins rhythm (23.05 ± 1.65 pg / ml, P< 0.001 vs before PTMC and P>50 vs control subjects. There was a significant correlation between the levels of beta-endorphin in the antecubital vein and heart rate (r = 0.502, P< 0.001), mean transmitral pressure gradient (r = 0.543, P< 0.001) or mitral valve area (r = -0.710, P< 0.001) before and 72 hours after the procedure.

Balloon Mitral Valvuloplasty in Rheumatic Double Orifice Mitral Valve

We are reporting four cases of acquired double orifice mitral valve (DOMV) of rheumatic etiology (rare) presenting as significant mitral stenosis (MS) treated successfully by percutaneous intervention. All four patients are young (3 males, 1 female) who presented with dyspnea of Newyork heart association (NYHA) class II with mean duration of 1.3 years. Typical clinical findings of MS were present in all. Echocardiography confirmed the diagnosis of moderate to severe MS of rheumatic etiology with double orifice of mitral valve of Trowitzsch incomplete bridge variety [1], giving appearance of two equal (like a pair of spectacles in one patient) or unequal size orifices (in three patients) in parasternal short axis view. Color Doppler examination revealed separate jets originating from each orifice, determined severity of the lesion and evaluated the eligibility for balloon mitral valvuloplasty (BMV). BMV was carried out under transeosophagial echo (TEE) guidance (for perfect septal puncture and crossing the separate orifices) using Inoue balloon of appropriate size (in accordance with patient’s height) with intention to break central fibrous strand converting into a single orifice. All four patients underwent successful BMV (clinical & ECHO criteria) after dilating the separate orifices (except case 4) but the fibrous strand could not be broken. Hence, this study shows that good results can be obtained in acquired double orifice mitral valve with significant MS with BMV even without breaking the fibrous strand. Considering rarity of isolated DOMV cases and rheumatic etiology being very rare, this report of four rheumatic acquired DOMV cases with successful BMV done with good result is significant.

EXPERIENCE OF PERCUTANEOUS BALLOON MITRAL VALVULPLASTY(PBMV)IN 35 PATIENTS

Since 1991,we have performed PBMV on 35 mitral stenosis patients(pts).Clinical data:35 pts(10males,25 females)Mad 39.5(23-59)yrs,were diagnosed asmitral stenosis by ecbocardiogram.The course of disease was 9(1-39)yrs exceptactive stage of rheumatic fever.The mitral valve thiclmess was 4-8mm.TheMitral Valve Area(MVA)was 1.05(0.7-1.4)cm^2.The pts without atrial thronbusipcluded light aortic regurgitstion(AR)in3,light mitral regurgitation(MR)in5,atrial fibrillation in11I,NYHA cardiac function Ⅱ-Ⅲ°.Single-ballcontochniqus was applied on them,6 with Japan-amde balloon,29 with China-madebelloon.The balloon diameter was 2A-28mm.Besults:32 pts were successful in PBMV.Acute cardiac tamponade occurred toone case.The thoracotomy bemostasis and the mitral commissurotomy wereperformed in time.2 Cases failed in Interatrial septal punctura.Rapid atrialfibrillation occured to 1 cese.Aftor electrical conversion.sinus rhythmresumsed,and the operation accomplished.The symptom was obviously improvedin the successful 32 pts.Diastolic murisur in apical region of heart decreasedor disappeared.MVA increased 0.91cm^2(p【0.01).Left atrial pressure andtransmitral pressure gradient decreased 20 and 2.2 Kp(p【0.01).Conclusion:PSMV was successful in 5 pts with light MR and 3 pts with light ARSubjective symptom was improved and MR did not increase.So that PBMV iseffective in Mitral atenosis pts with light MR or light AR 11 atrialfibrillation pta(no atrial thrombus)without anticoagulant before PBMV bad noembolism.The results indicate that anticongulant before operation isusslesseful,but left atrial thrombus must be excluded under ecbocardiogram.The main complication in artial septum punturs is perforation of heart.Cardiac tampomads occurred to 1 case bucauss the cannula entered too deeplyand broke the left pulmonary veins.The followings should be done to decressethe perforation of heart:1)Before operation the anatomical position variationof atrial septum must be detected completely to clear the point of puncture.2)When the needle break the atrial septum,the cannula must be pushed afterthe needle is just in the left atrium.depending on the bemospasia,thecontrast examination and left atrial pressure determination.3) The canmulamay not be pushed too deeply to break the left atrium or the pulmonary veins.4) After taking out the needle,the contrast exnmination and left atrialpressure determination must be done again to decide the next step.

Assessment of the Outcome of Severe Mitral Stenosis during Late Pregnancy

Objectives Percutaneous balloon mitral valvuloplasty (PBMV) is one way to improve the rheumatic mitral stenosis. How does the procedure work in gravida and fetus is not very clear. We analyzed the effects and safety of PBMV operation on pregnant patients with severe rheumatic mitral stenosis. Methods Eight pregnant patients suffering from severe mitral stenosis underwent facilitated PBMV operation with Inoue balloon, and were followed up for (2.0±1.1) years. Contents included outcome of pregnancy, infant growth, hemodynamics, echocardiography, cardiac function, mitral valves replacement or repeat valvuloplasty. Results Mitral valve area (MVA) before, one week and one year after facilitated PBMV were (0.84±0.21) cm2, (1.69±0.23) cm2 and (1.51±0.24) cm2 respectively. The transmitral pressure gradient dropped from (22.1±4.7) mm Hg to (9.9±3.1) mm Hg (P<0.001) (1 mm Hg=0.133 kPa). After facilitated PBMV, all patients showed remarkable immediate symptomatic and hemodynamic improvement without severe mitral regurgitation. All of these patients could maintain New York heart association (NYHA) Ⅰ or Ⅱ for (2. 0±1.1) years after the operation. Two patients demanded induced abortion concerning about the teratogenic effect of X-ray on fetus. All the other six patients continued their gestation and had full-term cesarean section without complications. Their newborns developed healthy and normally till now. Conclusions Facilitated PBMV is a feasible, safe and effective device for selected pregnant patients with mitral stenosis. The operation is well tolerated by the fetus.

Clinical experience of percutaneous m itralballoon valvuloplastyin 350 casesin Chinese and long term follow-up

Objectives: This study is to introduce of the clinical experience of percutaneous mitral balloon valvuloplasty 350 cases in Chinese and the long term follow up. Method: The modfied Inoue method was performed. Results: Effective PBMV was performed in 344 cases, the success rate was 98.3%:mitral area assessed by 2 dimenrional echocardiography (1.11±0.29 to 2.19 ±0.40cm 2, P <0.01 ). One hundrad and five patients were followed at a mean (46.7± 26.3 ) months (range 9 months to 8.5 years). after procedure restenosis was 11.4%(12/15), death 2.9 %(3/105, cerebral embolism in 2, congestive heart failure in 1; mitral valve replacement in 3.8%(4/105). Conclusions: percutaneous mitral commissurotomy provided excellent immediate and lale clinical results.

A PROSPECTIVE STUDY OF PATIENT-RELATED FACTORE INFLUENCING THE EFFICACY OF PERCUTANEOUS BALLOON CATHETER MTRAL VALVULOPLASTY BY A SET OF MODIFIED ECHOCARDIOGRAPHIC SCORE IN 115 SUBJECTS

The goal of the present study was to determine whether the patient-relatedfactors such as mitral valve morphological features influence the efficacyof percutaneous balloon catheter mitral valvuloplasty(PBMV)with Inoueballoon catheter,A set of modified echocardiographic total score(ETS),in which each score was assigned for each mitral valve morphologicalfeature such as valvular mobility,thickening,calcification or subvalvularthickening on a scare ranging from 1 to 4,used for a prospective cohortstudy of different fiTS in 115 subjects with mitral stenosis hut withoutsignificant mitral regurgitation.It was found that the efficacy of PBMVafter the procedure was significantly better in the low ETS(≤8 points)group(n=61,included 43 women;ages 18 to 57 years,mean 39)than inthe high ETS(】8 points) group(n=54,included 37 women;ages 17 to 58years,mean 40)in mitral valve area (2.32+0.46 cm^2vs 1.87±0.37cm^2,p【0.01),mean left atrial pressure(12±5 mmHg vs 18±7 mmHg,p【0.01),mean mitral valve pressure gradient(4±1 mmHg vs 10±2 mmHg,p【0.01),and left atrial dimension(34.9±5.2mm vs 41.2±6.9 mm,p【0,01).In the low ETS group,mitral valve area was 2.30±0.45 cm^2(NS)and leftatrial dimension was 35.2±5.5mm(NS)at 12-30(24±7)monthsfollow-up.In contrast,in the high ETS group,mitral valve areadecreased to 1.58±0.36 cm^2(p【0.01)and left atrial dimension incresed to45.2±7.4mm(p【0.05) at 12-36 months follow-up.In addition,restenosiswas demonstrated in 12 of 54 patients(22%)with a high ETS but only in2 of 61 patients(3%.p【0.01) with a low ETS at follow-up.Thus,thepatients with a morphological suitable valve for PBMV or a low ETS mayget a better efficacy from PBMV,and ETS mey be very useful in selectingpatient for the procedure.

Mitral Valve Commissurotomy: Which One between the Three Techniques Gives a Better Long-Team Outcome?

Objective: we sought to compare long-term results of three techniques: CMC, OMC and PMC in patients with rheumatic mitral stenosis. Patients and Method: Between January 1994 and December 2015, 183 patients underwent mitral valve surgery for rheumatic mitral restenosis. All patients were investigated by echocardiography-Doppler performed by a senior cardiologist. The patients were divided into 3 groups: patients who have previously closed mitral commissurotomy (CMC n = 101), patients with previously open mitral commissurotomy (OMC n = 28) and those treated by Balloon mitral valvuloplasty (PMC = 54). Results: The three groups were comparable in term of major demographic data. Mitral restenosis occurred precociously in groups treated by PMC (7 ± 4 years), followed by group with OMC 11.4 ± 4 years and CMC group but it occurred later CMC 16.8 ± 7.8 years (p Conclusion: CMC produces better long-term outcome than OMC and PMC. However, it would be premature to conclude to its superiority.