Redo Percutaneous Mitral Valvuloplasty (Redo PMV) in Patients With Recurrent Mitral Valve Stenosis: Immediate and Early Outcomes

Document Type: Original article

Authors

1 Research Center of Endovascular Intervention, Department of Interventional Cardiology, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Interventional Cardiology, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

3 University of Toronto, Mount Sinai Hospital,700 University Avenue , 3rd floor, Room 3-522,Toronto, ON, M5G Canada

4 University of Arizona,Tucson, Arizona, USA

5 Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Symptomatic recurrent mitral valve stenosis develops in some patients after Percutaneous Mitral Valvuloplasty (PMV). This study assessed the immediate and early outcomes of redo PMV in patients with recurrent mitral valve stenosis after prior PMV.
Methods: Fifty-four patients (40 women and 14 men, mean age of 38±8.2 years) underwent a redo (second) PMV for symptomatic restenosis of mitral valve [with Mitral Valve Area (MVA) < 1.5 cm2]. Redo PMV was performed at 5.8±1.2 years after the initial PMV.
Results: In this study, 48 hours after the procedure, there was a substantial increase in MVA by 2-dimensional Echocardiography (GE, Vivid 7) from 1.0±0.2 to 2.2±0.4 cm2 (p<0.001) and a decrease in mean left atrial pressure from 27 ± 5 to 15 ± 4 mmHg (p<0.001) and in mean transmitral valve gradient from 15±4 to 2±1 mmHg (p <0 .001). Mean pulmonary artery pressure did not change significantly with redo procedure. Good immediate result was achieved in 53 patients (98.15%).
Conclusion: Redo PMV can be performed successfully in patients with recurrent mitral valve stenosis following previous percutaneous valvuloplasty.

Keywords


1. Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg 1984;87(3):394-402.
2. Palacios IF, Silva GV. Percutaneous mitral balloon valvuloplasty: surviving the test of time. Revista Brasileira de Cardiologia Invasiva 2012;20(3):237-8.
3. Carroll JD, Feldman T. Percutaneous mitral balloon valvotomy and the new demographics of mitral stenosis. JAMA 1993;270(14):1731-6.
4. Vavuranakis M, Stratos C, Kalogeras K, Aggeli C, Tsiachris D, Vaina S, et al. An alternative method of percutaneous mitral valvuloplasty. Matching electrophysiology with interventional cardiology techniques. Int J Cardiol 2015;191:294-5.
5. Palacios IF, Tuzcu ME, Weyman AE, Newell JB, Block PC. Clinical follow-up of patients undergoing percutaneous mitral balloon valvotomy. Circulation 1995;91(3):671-6.
6. Hernandez R, Banuelos C, Alfonso F, Goicolea J, Fernández-Ortiz A, Escaned J, et al. Long-term clinical and echocardiographic follow-up after percutaneous mitral valvuloplasty with the Inoue balloon. Circulation 1999;99(12):1580-6.
7. Rifaie O, Ismail M, Helmy M, El-Bialy M, Nammas W. Redo percutaneous mitral valvuloplasty for mitral restenosis: a comparison with first procedure for de novo mitral stenosis. Kardiologia Polska (Polish Heart Journal) 2011;69(2):125-31.
8. Rifaie O, Ismail M, Helmy M, El-Bialy M, Nammas W. Redo percutaneous mitral valvuloplasty for mitral restenosis: a comparison with first procedure for de novo mitral stenosis. Kardiologia polska. 2010;69(2):125-31.
9. Iung B, Garbarz E, Michaud P, Fondard O, Helou S, Kamblock J, et al. Immediate and mid-term results of repeat percutaneous mitral commissurotomy for restenosis following earlier percutaneous mitral commissurotomy. European Heart J 2000;21(20):1683-9.
10. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J American College of Cardiology 2017.
11. Wilkins G, Weyman AE, Abascal V, Block P, Palacios I. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988;60(4):299-308.
12. Nobuyoshi M, Arita T, Shirai S-i, Hamasaki N, Yokoi H, Iwabuchi M, et al. Percutaneous balloon mitral valvuloplasty: a review. Circulation 2009;119(8):e211-e9.
13. Tastan A, Ozturk A, Senarslan O, Ozel E, Uyar S, Ozcan EE, et al. Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty: which is preferable? Cardiovascular J Africa 2016;27(3):147.
14. Hung JS. Atrial septal puncture technique in percutaneous transvenous mitral commissurotomy: mitral valvuloplasty using the Inoue balloon catheter technique. Catheterization and Cardiovascular Diagnosis 1992;26(4):275-84.
15. Babaliaros VC, Green JT, Lerakis S, Lloyd M, Block PC. Emerging applications for transseptal left heart catheterization: old techniques for new procedures. J Am Coll Cardiol 2008;51(22):2116-22.
16. Naik N. How to perform transeptal puncture. Indian Heart J 2015;67(1):70-6.
17. Ben-Farhat M, Betbout F, Gamra H, Maatouk F, Ben-Hamda K, Abdellaoui M, et al. Predictors of long-term event-free survival and of freedom from restenosis after percutaneous balloon mitral commissurotomy. Am Heart J 2001;142(6):1072-9.
18. Iung B, Garbarz E, Doutrelant L, Berdah P, Michaud P, Farah B, et al. Late results of percutaneous mitral commissurotomy for calcific mitral stenosis. American J Cardio 2000;85(11):1308-14.
19. Ali L, Asghar N, Riaz R, Hussain M. Percutaneous transmitral commissurotomy (PTMC); procedural success and immediate results, a tertiary care hospital experience from develping country. Professional Medical J 2016;23(1).
20. Dean LS. Complications and mortality of percutaneous balloon mitral commissurotomy. Circulation 1992;85(6):2014-24.
21. Bouleti C, Iung B, Brochet E, Messika-Zeitoun D, Himbert D, Garbarz E, et al. The impact of the presence and extent of valve calcification on long-term results of percutaneous mitral commissurotomy. Archives of Cardiovascular Diseases Supplements 2013;5(1).
22. Esteves WAM, Lodi-Junqueira L, Soares JR, Athayde GRSA, Goebel GA, Carvalho LA, et al. Impact of percutaneous mitral valvuloplasty on left ventricular function in patients with mitral stenosis assessed by 3D echocardiography. Int J Cardiol 2017 Dec 1;248:280-5.
23. Harken DE, Black H, Taylor WJ, Thrower WB, Ellis LB. Reoperation for mitral stenosis. Circulation 1961;23(1):7-12.
24. Ellis LB, Singh JB, Morales DD, Harken DE. Fifteen-to twenty-year study of one thousand patients undergoing closed mitral valvuloplasty. Circulation 1973;48(2):357-64.
25. John S, Bashi V, Jairaj P, Muralidharan S, Ravikumar E, Rajarajeswari T, et al. Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients. Circulation 1983;68(5):891-6.
26. Palacios IF, Block PC, Wilkins GT, Weyman AE. Follow-up of patients undergoing percutaneous mitral balloon valvotomy. Analysis of factors determining restenosis. Circulation 1989;79(3):573-9.
27. Pan M, Medina A, de Lezo J, Hernández E, Romero M, Pavlovic D, et al. Factors determining late success after mitral balloon valvulotomy. Am J Cardiol 1993;71(13):1181-5.
28. Block PC, Palacios IF, Block EH, Tuzcu EM, Griffin B. Late (two-year) follow-up after percutaneous balloon mitral valvotomy. Am J Cardiol 1992;69(5):537-41.
29. Shavelle DM, Otto CM, Tavel ME. Recurrent mitral stenosis: Problems of management. CHEST J 2001;119(3):958-60.
30. Dean LS, Mickel M, Bonan R, Holmes DR, O’Neill WW, Palacios IF, et al. Four-year follow-up of patients undergoing percutaneous balloon mitral commissurotomy A report from then national heart, lung, and blood institute balloon valvuloplasty registry. J American College of Cardiology 1996;28(6):1452-7.
31. Chmielak Z, Klopotowski M, Kruk M, Demkow M, Konka M, Chojnowska L, et al. Repeat percutaneous mitral balloon valvuloplasty for patients with mitral valve restenosis. Catheterization and Cardiovascular Interventions 2010;76(7):986-92.
32. Gil IJN, Palacios-Rubio J, Bautista D, Salinas P, Macaya C, Fernández-Ortiz A. Long-term results of repeat percutaneous mitral valvuloplasty: Is it still a viable option? Revista Española de Cardiología 2015;68(08):728-30.
33. Pathan AZ, Mahdi NA, Leon MN, Lopez-Cuellar J, Simosa H, Block PC, et al. Is redo percutaneous mitral balloon valvuloplasty (PMV) indicated in patients with post-PMV mitral restenosis? J American College of Cardiology 1999;34(1):49-54.
34. Bouleti C, Iung B, Himbert D, Messika-Zeitoun D, Brochet E, Garbarz E, et al. Long-term impact of repeat percutaneous mitral commissurotomy on the need for surgery in mitral stenosis. Insights from a series of 912 patients with a 20-year follow-up. Archives of Cardiovascular Diseases Supplements 2012;4(1):90-1.
35. Aslanabadi N, Golmohammadi A, Sohrabi B, Kazemi B. Repeat percutaneous balloon mitral valvotomy vs mitral valve replacement in patients with restenosis after previous balloon mitral valvotomy and unfavorable valve characteristics. Clin Cardiol 2011;34(6):401-6.
36. Song JK, Song JM, Kang DH, Yun SC, Park DW, Lee SW, et al. Restenosis and adverse clinical events after successful percutaneous mitral valvuloplasty: immediate post-procedural mitral valve area as an important prognosticator. Eur Heart J 2009;30(10):1254-62.