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.

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.

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.

ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PRE-AND POST-PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Transesophageal echocardiogram (TEE) was performed in 33 consecutive patients with both rheumatic mitral stenosis and chronic atrial fibrillation to evaluate tfae usefulness of this technique for the detection of left atrial thrombi, mitral regurgitation before percutaneous balloon mitral valvuloplasty and iatrogenic atrial septal defect after the procedure. TEE correctly identified thrombi in 10 (30%) patients and significant mitral regurgitation in 5 patients who underwent surgical intervention. The remaining 18 patients underwent percutaneous balloon mitral valvuloplasty without evidence of systemic embolic event and obtained adequate outcome. Transesophageal color doppler echocardiography demostrated left-o-ight shunting flow through atrial septum in 5 of 7(71%) patients 3 days after the procedure and repeated TEE in 2 of these 5 patients showed no shunting after 6 months. In conclusion, TEE plays a definite role in the selection of patients for balloon mitral valvuloplasty and assessment of iatrogenic atrial septal defect.

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.

Percutaneous balloon mitral valvuloplasty during pregnancy:A clinical analysis of 14 cases

Background Although acute rheumatic fever and rheumatic heart disease are now rare in affluent populations,they remain major health issues in developing countries such as China. Rheumatic mitral stenosis is the most common valvular disease during pregnancy. Some patients can receive percutaneous balloon mitral valvuloplastyduring pregnancy and obtain good outcomes. Methods A retrospective study of 14 women undergoing percutaneous balloon mitral valvuloplasty with rheumatic mitral valve stenosis during pregnancy in our hospital from Jan 2014 to Oct 2019 was conducted. The maternal and fetal outcomes were analyzed. Results Percutaneous balloon mitral valvuloplasty was successful in all patients with significant improvement in their mitral valve area(pre-operation:0.83±0.21 cm^2 and post-operation:1.64±0.27 cm^2,P<0.05). Pulmonary artery systolic pressure(pre-operation:69.62±28.27 mmHg and post-operation:37.23±12.65 mmHg,P<0.05)was significantly decreased. All 14 patients had an uneventful course afterthe operation. The total number of newborns was 14,none of whom required intensive care monitoring,and no malformations were found. Conclusions Percutaneous balloon mitral valvuloplasty performed during pregnancy with necessary precautions is feasible and effectivefor the mother and mightbe safe forthe fetus. There is marked symptomatic relief,along with good maternal and fetal outcomes.

Five-year Follow-up after Percutaneous Mechanical Mitral Commissurotomy

Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97.1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0.87±0.15) cm2, (2.11±0.38) cm2 and (1.81±0.36) cm2, respectively (P<0.01). Five-year mitral restenosis rate was 6.1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.

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.