Objective: To investigate the short and long-term outcome post percutaneous balloon mitral valvuloplasty (PBMV) in mitral valve stenosis patients with different mitral valve morphology.
Methods: Mitral valve morphology was graded according to the Wilkins scoring system, 385 eligible patients were divided into echocardiographic scores > 8 group (n = 125) and ≤ 8 group (n = 260). Patients were followed up after PBMV according to the improved Inoue method.
Results: PBMV was successful in 370 patients, the success rate of PBMV in > 8 group was significantly lower than in ≤ 8 group (92.8% vs. 97.7%, P < 0.05). Hemodynamic parameters improved significantly in both groups (all P < 0.05) at 6 months post PBMV. Compared to pre-PBMV, improvement on left atrial mean pressure [(14.22 ± 5.02) mm Hg vs. (15.44 ± 5.19) mm Hg (1 mm Hg = 0.133 kPa)], pulmonary artery systolic pressure [(26.13 ± 9.27) mm Hg vs. (31.93 ± 9.98) mm Hg], mitral valve gradient [(9.21 ± 4.11) mm Hg vs. (10.16 ± 4.21) mm Hg] and area of mitral valve orifice [(1.02 ± 0.15) cm(2) vs. (1.20 ± 0.22) cm(2)] post PBMV was less in > 8 group (116 cases) than those in ≤ 8 group (254 cases, all P < 0.05). Three hundreds and fifty three patients were followed up for (78 ± 20) months. Echocardiographic parameters post PBMV improved significantly in both groups compared with the pre-PBMV values during follow-up (all P < 0.05). However, left atrial mean pressure, pulmonary artery systolic pressure, mitral valve gradient and area of mitral valve orifice in > 8 group (108 cases) improved less than those in ≤ 8 group (245 cases) [(13.28 ± 5.06) mm Hg vs. (14.77 ± 5.17) mm Hg, (21.19 ± 9.17) mm Hg vs. (28.92 ± 9.91) mm Hg, (7.30 ± 4.40) mm Hg vs. (9.16 ± 4.28) mm Hg, (0.92 ± 0.17) cm(2) vs. (1.07 ± 0.20) cm(2); all P < 0.05]. The incidence of mitral restenosis was also significantly higher in > 8 group than in ≤ 8 group (20.4% vs. 8.2%, P < 0.05).
Conclusions: The mitral valve morphology played a key role on the outcome post PBMV in patients with mitral valve stenosis. Patients with lower echocardiographic scores benefit more from PBMV than patients with higher echocardiographic scores.