PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY - ANALYSIS OF ECHOCARDIOGRAPHIC AND OTHER VARIABLES RELATED TO OUTCOME

To determine whether mitral valve (MV) morphology influences the resul t of balloon mitral valvuloplasty (BMV) for mitral stenosis, two-dimen sional echocardiography was performed before BMV in 53 patients and in 25 normal controls. The two-dimensional echocardiographic features of MV leaflets: thickness, length and motion, diastolic MV excursion, ch ordal length, MV annular diameter (MVAnD), subvalvular distance ratio (SDR), and effective balloon dilating area (EBDA) and diameter (EBDD) were then correlated to the immediate post-BMV mitral valve area (MVA) . For the total patient population, post-BMV MVA increased from 0.76 /- 0.24 to 1.91 +/- 0.59 cm2 (p < 0.0001) and mean diastolic transmitr al gradient decreased from 20.1 +/- 6.15 to 5.8 +/- 3.29 mm (p < 0.000 1). The patients were divided into two groups on the basis of post-BMV MVA. Group I had post-BMV MVA <2.0 CM2 and group II had post-BMV MVA greater-than-or-equal-to 2.0 CM2. A statistically significant differen ce was noted in SDR (0.33 +/- 0.057 vs 0.45 +/- 0.042, p < 0.0001); mi d-MV anulus to tip of papillary muscle (PM) distance (20.0 +/- 3.8 vs 27.9 +/- 4.54 mm, p < 0.0001); chordal length (4.3 +/- 3.6 vs 9.8 +/- 3.9 mm, p < 0.0001); diastolic MV excursion (15.5 +/- 2.6 vs 18.2 +/- 4.2 mm, p < 0.01); leaflet mobility (p < 0.05); and EBDA (4.4 +/- 0.6 vs 4.9 +/- 0.5 CM2, p < 0.01). On discriminant function analysis of al l the echocardiographic variables, the SDR had the strongest discrimin ating power, followed by mid-MV anulus to tip of PM distance, EBDD/MVA nD, and EBDA/body surface area (BSA), and had an accuracy of 90.6% for correctly differentiating two groups. We conclude that quantitative a ssessment of SDR, mid-MV anulus to tip of PM distance, EBDD/MVAnD by t wo-dimensional echocardiography, and EBDA/BSA are helpful in predictin g the immediate outcome of BMV.