EARLY AND LATE RESULTS OF PERCUTANEOUS MITRAL VALVULOPLASTY FOR MITRAL-STENOSIS ASSOCIATED WITH MILD MITRAL REGURGITATION

To assess the influence of mild mitral regurgitation (MR) on the initi al and long-term results of percutaneous mitral valvuloplasty (PMV), t he baseline characteristics, early results and follow-up of 102 consec utive patients with mild MR before PMV (group I) were prospectively an alyzed and compared with those of 186 consecutive patients without MR (group II). Age, gender and symptomatic status were similar in both gr oups, but more patients in group I were in atrial fibrillation (70 vs 54%, p < 0.05) and had a previous episode of pulmonary edema (35 vs 14 %, p < 0.05). On echocardiography, patients in group I had larger left atria (58 +/- 12 vs 53 +/- 10 mm, p < 0.05) and more calcified mitral valves (score 1.9 +/- 0.8 vs 1.5 +/- 0.7, p < 0.05), but the total ec hocardiographic score (8.0 +/- 2 vs 7.3 +/- 2) was similar in both gro ups. Baseline hemodynamic data were also similar in both groups. On mu ltivariate analysis, group I patients were only independently associat ed with more calcified mitral valves and larger left atria. PMV succes s (area gain greater-than-or-equal-to 50% without complications) was s imilar (88 vs 86%) in both groups, but mitral valve area gain was smal ler (0.8 +/- 0.3 vs 1.0 +/- 0.3 cm2, p < 0.05) in group I. After PMV a n increase in the severity of MR greater-than-or-equal-to 2 grades (17 vs 6%, p < 0.05) occurred more frequently in group II patients. Altho ugh the incidence of severe MR after PMV (6 vs 7%) was similar in both groups, the number of patients with moderate MR after PMV was eventua lly higher in group I (31 vs 11%, p < 0.05). Follow-up studies were ob tained in 198 patients (92% eligible). At last follow-up (18 +/- 13 mo nths), 22 patients (11%) developed restenosis, 2 required mitral valve replacement and 3 patients died. On actuarial analysis the event-free survival at 2 years was higher in group II (88 vs 71%, p < 0.05). Thu s, patients with mild MR undergoing PMV have more calcified mitral val ves, larger left atria, and obtain a similar success rate that other p atient, although with smaller increments in mitral valve area. These p atients should be closely followed since they are less frequently even t-free at follow-up.