PATHOMORPHOLOGICAL CHARACTERISTICS OF RESECTED MITRAL-VALVES AFTER UNSUCCESSFUL VALVULOPLASTY

Objective. Percutaneous mitral valvuloplasty has been shown to be an a cceptable alternative to surgery as treatment for selected patients wi th severe mitral stenosis. We examined hemodynamic, echocardiographic, and pathomorphologic findings in a series of 308 patients undergoing balloon valvuloplasty, 41 of whom underwent subsequent surgery, in sea rch of possible predictors of an unsuccessful outcome. Intervention an d results. Patients with severe mitral stenosis underwent Inoue single balloon valvuloplasty over a 48-month period and had follow-up for a mean of 14.5+/-16.8 months (range 1 to 64 months). Of the 308 patients , 267 (Group I) were clinically improved and stable throughout follow- up, while subsequent surgery was required in 41 (Group II) after 38.2/-143.5 days (range 1 to 1212), Significant differences between the gr oups were observed for NYHA class (2.7+/-0.6 vs 2.9+/-0.6, p<0.05), mi tral valve area (1.0+/-0.3 us 0.9+/-0.2 cm(2), p<0.01) and left atrial endsystolic dimension by echo (51.3+/-8.0 vs 55.4+/-10.2 mm, p<0.01), Two of the 41 Group II patients underwent surgery for left to right s hunting, 1 for tamponade and 2 were lost to follow-up. The excised mit ral valves of the remaining 36 patients all showed calcification and/o r fibrosis: 9 homogenous, 5 non-homogenous; 19 were classified as havi ng a funnel-shaped deformity, and 3 did not fit into a discrete catego ry. Among the funnel-shaped valves, 13 had a tear versus 6 where dilat ion was primarily accomplished by stretching. Only one of 9 valves wit h homogenous calcification was torn, whereas a tear was noted In 3 of the 5 with nonhomogenous calcification. Conclusion. Funnel-shaped valv es and those with non-homogenous distribution of calcification and/or fibrosis appear to be least suitable for balloon valvuloplasty.