Document Detail


Inoue balloon mitral valvuloplasty: long-term clinical and echocardiographic follow-up of a predominantly unfavourable population.
MedLine Citation:
PMID:  11032696     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To assess long-term outcome in a typical Western population of predominantly unfavourable patients undergoing Inoue balloon mitral valvuloplasty. Outcome amongst patients has only been undertaken in the medium term. Long-term echocardiographic data in particular are scarce. METHODS: Inoue mitral valvuloplasty was attempted in 106 patients. There were six technical failures; the procedure was therefore completed in 100 patients, who underwent annual clinical and echocardiographic follow-up. RESULTS: Patients were aged 63.5+/-10. 3 years. 82% were female. Unfavourable characteristics included age >65 (52%), NYHA class III or IV (87%), >/=1 significant co-morbidity (63%), atrial fibrillation (82%), previous surgical commissurotomy (25%) and echocardiographic score >8 (59%, mean 8.9+/-2.1). Mitral valve area increased from 0.98+/-0.23 to 1.54+/-0.31 cm(2). There were three major complications. Post-procedure, symptoms improved in 88% of patients. Haemodynamic success (mitral valve area increase >50%, final mitral valve area >1.5 cm(2), mitral regurgitation </=grade 2) was achieved in 61% of cases. Mean follow-up was 4.3+/-1. 4 years. Survival was 97%, 88% and 82% at 1, 3 and 6 years. Event-free survival (freedom from death, mitral valve replacement or repeat valvuloplasty) was 96%, 82% and 56% at 1, 3 and 6 years. Freedom from restenosis (loss of >50% gain in mitral valve area, mitral valve area <1.5cm (2)) was 98%, 92% and 75% at 1, 3 and 6 years. Pre-procedural predictors of event-free survival were male sex, absence of co-morbidities, lower echocardiographic score and smaller left atrial diameter. CONCLUSIONS: In a Western population with predominantly unfavourable characteristics for mitral valvuloplasty, long-term outcome post-procedure is reasonable. A moderate increase in mitral valve area can be achieved at low procedural risk, and the subsequent rate of restenosis is low. Nonetheless, 6 years after the procedure, half of the patients will have required further intervention or died. For fitter patients willing to accept significant operative risk, mitral valve replacement remains a valuable alternative.
Authors:
D J Hildick-Smith; G J Taylor; L M Shapiro
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European heart journal     Volume:  21     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-12-26     Completed Date:  2001-01-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1690-7     Citation Subset:  IM    
Copyright Information:
Copyright 2000 The European Society of Cardiology.
Affiliation:
Cardiac Unit, Papworth Hospital, Cambridge, U.K.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Balloon Dilatation* / adverse effects
Echocardiography*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mitral Valve Stenosis / therapy*,  ultrasonography*
Retrospective Studies
Survival Analysis
Treatment Outcome
Comments/Corrections
Comment In:
Eur Heart J. 2000 Oct;21(20):1651-2   [PMID:  11032691 ]
Eur Heart J. 2000 Oct;21(20):1649-51   [PMID:  11032690 ]

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