E. Miche et al., PATHOMORPHOLOGICAL CHARACTERISTICS OF RESECTED MITRAL-VALVES AFTER UNSUCCESSFUL VALVULOPLASTY, Journal of Cardiovascular Surgery, 37(5), 1996, pp. 475-481
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.