Percutaneous balloon valvuloplasty for mitral stenosis complicated by fatal pericardial tamponade in a patient with extreme pulmonary hypertension (original) (raw)
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Cardiology Journal, 2016
Background: The primary goal of this study is to evaluate the immediate and long-term effects of percutaneous mitral balloon valvuloplasty (PBMV) on patients with rheumatic mitral stenosis (MS) complicated with severe pulmonary hypertension (PH). Methods: The study population consisted of 85 patients with MS complicated with severe PH (systolic pulmonary pressure > 75 mm Hg). PBMV was performed with Inoue balloon technique. Clinical and echocardiographic follow-up was scheduled at 6 months and 1 year and yearly thereafter. Results: Mitral valve area (MVA) was increased (pre-PBMV MVA was 1.03 ± 0.21 cm 2 , post-PBMV MVA 1.89 ± 0.34 cm 2 , p < 0.001) significantly. The mean and the maximum transmitral pressure gradient significantly decreased (pre-PBMV mean transmitral gradient
BMC Anesthesiology, 2021
Background The World Symposium of Pulmonary Hypertension in 2018, updated the definition of pulmonary hypertension (PH) as mean pulmonary artery pressures (PAP) > 20 mmHg. Pulmonary venous hypertension secondary to left-heart disease, constitutes the most common cause of PH, and the determination of a co-existent pre-capillary (primary) PH becomes paramount, particularly at the moment of evaluating and managing patients with heart failure. Pulmonary artery pressures above the systemic pressures define supra-systemic PH and generally leads to frank right ventricular failure and high mortality. Case presentation We present the perioperative management of a patient with rheumatic mitral valve disease, initially found to have severe PH due to pulmonary venous hypertension, who underwent percutaneous mitral balloon valvuloplasty complicated with mitral chordae rupture, severe mitral regurgitation and supra-systemic PH. Multiple medical therapies and an intra-aortic balloon pump were u...
Cardiology Journal, 2016
Background: The primary goal of this study is to evaluate the immediate and long-term effects of percutaneous mitral balloon valvuloplasty (PBMV) on patients with rheumatic mitral stenosis (MS) complicated with severe pulmonary hypertension (PH). Methods: The study population consisted of 85 patients with MS complicated with severe PH (systolic pulmonary pressure > 75 mm Hg). PBMV was performed with Inoue balloon technique. Clinical and echocardiographic follow-up was scheduled at 6 months and 1 year and yearly thereafter. Results: Mitral valve area (MVA) was increased (pre-PBMV MVA was 1.03 ± 0.21 cm 2 , post-PBMV MVA 1.89 ± 0.34 cm 2 , p < 0.001) significantly. The mean and the maximum transmitral pressure gradient significantly decreased (pre-PBMV mean transmitral gradient
Predictors of Complications During Percutaneous Multitrack Balloon Mitral Valvuloplasty
International Journal of Cardiovascular Research, 2020
Introduction: Mitral Stenosis (MS) is characterized by a decrease in Mitral Valve (MV) orifice area leading to compromised left ventricular filling. The consequence is stagnation of blood proximal to the MV that results in elevated left atrial, pulmonary venous, and pulmonary artery pressure. Aim of the work: Trace the complication of mitral regurgitation during the procedure percutaneous Balloon Mitral Valvuloplasty (PMV) by using multitrack balloon. Subjects and methods: This interventional non-randomized cohort study was conducted on 121 patients who presented with moderate to severe MS and subjected to PMV using multitrack balloon technique and were divided into 2 groups, according to resultant mitral regurgitation: Group A: included patients with no or mild mitral regurgitation and Group B: included patients with severe mitral regurgitation. Results: Multivariate regression identified MV balloon sizing (OR 3.877, CI 95% 1.131-13.289, P value 0.031), MV commissural asymmetry (OR...
Heart, Lung and Circulation, 2017
Percutaneous balloon mitral valvuloplasty (PMV) is an attractive therapeutic approach in patients with mitral stenosis. The aim of this study was to assess the immediate and long-term clinical, echocardiographic and haemodynamic outcomes of PMV in patients with severe pulmonary hypertension (PAH). Methods Percutaneous balloon mitral valvuloplasty was performed in 157 consecutive patients; 60 patients (38.2%) had significant PAH defined as baseline pulmonary artery mean pressure (PAMP) ! 30 mm Hg (Group 1) and 97 patients (61.8%) had PAMP 30 mmHg (Group 2). Pulmonary artery systolic pressure (PASP), mortality, need for mitral valve replacement or new PMV, and valve restenosis were evaluated during follow-up. Results Mean age was 44.2 years and 88.5% (139 patients) were women. Primary success was achieved in 79.6% of the patients (125 patients) without differences between the groups. Mitral valve area increased from 0.90 cm 2 to 1.76 cm 2 , PASP fell from 57 mmHg to 35 mmHg in Group 1 and from 38 mmHg to 30 mmHg in Group 2. Median PASP in Group 1 was 35, 32, 36, 38 and 34 mmHg at 12, 24, 36, 48 and 60 months. There were no significant differences in mitral valve area, PASP and clinical status between the groups. Conclusion Percutaneous balloon mitral valvuloplasty is a safe and effective technique for the treatment of patients with mitral stenosis and PAH. A significant decrease in pulmonary pressure was observed after valvuloplasty. Although there was a gradual decrease of MVA at long-term follow-up, most patients remained asymptomatic and PASP was stable.
Percutaneous Mitral Balloon Valvuloplasty: Technique and Results
2021
Background: Percutaneous balloon mitral valvuloplasty is a procedure used to dilate the mitral valve in cases of rheumatic mitral stenosis. The catheter is inserted into the female vein to the right atrium and atrial septum. The mitral valve is then passed through the inflated balloon to facilitate effective integration of mitral adhesions, which increases the area of the mitral valve and decreases the rate of mitral stenosis. Mitral regurgitation is a potential problem, and thus balloon percutaneous mitral valvuloplasty (PBMV) is prevented in moderate to severe relapse. The Wilkins score studies mitral valve morphology and evaluation by echocardiography to assess the viability of PBMVs based on specific echocardiographic conditions. Conclusion: There are many factors in the immediate and long-term outcomes of patients undergoing PMV. Echo-Sc can be used in combination with other clinical and morphological predictions of PMV effects to identify patients who experience the best effects on PMV.
Mitral valve disruption following percutaneous balloon valvuloplasty
Catheterization and Cardiovascular Diagnosis, 1990
Two cases of massive mitral regurgitation due to mitral valve disruption following percutaneous balloon valvuloplasty are reported. This severe complication occurred in two elderly women with recurrent mitral stenosis after previous surgical commissurotomy. Due to their unstable hemodynamic and clinical condition, both patients underwent emergency valve replacement. At surgery, the commissures appeared fused and heavily calcified; the chordae tendineae thickened, shortened, and fused; and the leaflets presented a large tear with sheared edges. Because the technical aspects of both procedures were unremarkable, the anatomic features of the mitral valve seemed to affect the occurrence of severe mitral regurgitation. Percutaneous balloon valvuloplasty should be therefore applied carefully to patients with prior surgical valvotomy, in whom the structural alterations of the mitral apparatus may predispose to severe valvular damage.
Percutaneous mitral balloon valvuloplasty: beyond classic indications
Kardiologia Polska
Background and aim: In patients with mitral stenosis (MS) percutaneous mitral balloon valvuloplasty (PMBV) is used to improve symptoms and prognosis. Although there is some evidence for potential long-term benefits from PMBV in asymptomatic patients with mitral valve area (MVA) between 1.0 and 1.5 cm 2 , there are no follow-up data on patients with symptomatic MS with MVA > 1.5 cm 2 , who underwent PMBV. Methods: We retrospectively analysed periprocedural results of 113 symptomatic patients who underwent PMBV for MS with MVA > 1.5 cm 2 (group 1) and compared them with a control group of patients with MVA ≤ 1.5 cm 2 (group 2). Clinical and procedural variables were compared between groups. Results: In group 1, PMBV resulted in a significant increase of MVA as well as a decrease of mean and maximal mitral gradients and mean left atrial pressure (LAP), and a subsequent decrease of mean and systolic pulmonary artery pressures (PAPs). Moreover, 6.3% of patients developed moderate to severe (3+) or severe (4+) post-procedural mitral regurgitation (MR). Post-procedural increase in MVA and decrease of LAP were more pronounced in group 2 than group 1 (∆MVA 0.74 cm 2 vs. 0.41 cm 2 , p < 0.05, and ∆LAP 8.2 mmHg vs. 6.0 mmHg, p < 0.05). Nonetheless, no significant differences were observed for ∆ of mean and systolic PAPs. The grade of post-procedural MR was comparable between groups. Conclusions: PMBV is a feasible procedure in highly selected patients without classic echocardiographic indications. Nonetheless, it is associated with a small but non-negligible periprocedural risk of developing severe MR.
Mitral valvuloplasty complicated by catheter perforation of the right atrium and the aortic root
Authorea (Authorea), 2020
According with latest guidelines, percutaneous mitral commissurotomy (PMC) represents the first-line treatment for symptomatic severe mitral valve stenosis (SMVS) with favourable morphology, We report a successful surgical treatment of a potential life-threatening complication occurred during PMC. Heart-Team discussion and closed collaboration with Centres are crucial for decision-making and Cardiac Surgery onsite should be ensured for high-risk procedures. Case report A 77-year-old female with symptomatic SMVS was admitted to a secondary referring Hospital. Transoesophageal echocardiography demonstrated a SMVS (valve area 0,9-1 cm 2 and mean gradient of 17 mmHg), with commissural fusion, diffused calcification of the annulus and leaflets, and no mitral regurgitation. LVEF was 60% and there were no left atrial thrombi. Severe pulmonary hypertension (PAPs 85 mmHg) was identified.