Influence of sub valvular pathology on immediate results and follow up events of Inoue balloon mitral valvotomy

We evaluated the influence of sub valvular pathology (SVP) on the immediate results and follow up events of Inoue Balloon Mitral Valvotomy (IBMY) in 2 06 patients with severe SVP (Group I) and compared their outcome with 206 a ge and sex matched patients selected from the rest of 619 patients having m ild/moderate SVP (Group II). Pre-procedure echocardiographic recordings wer e reviewed and mitral valve morphology was evaluated using U.S. California Score. The severe SVP group had lower mitral valve areas (MVA) (0.7 cm(2) v s. 0.8 cm(2)) and higher mean pulmonary artery pressure (MPAP) (46.3+/-16.9 mmHg vs. 40.7+/-16.25 mmHg) and mean pulmonary capillary wedge pressure (P CWP) (27.5+/-7.3 mmHg vs. 25.7+/-8.0 mmHg) (p<0.001). IBMV was done using s tandard technique. The procedure was technically successful in 192/206 pati ents (93.2%) in group I and 187/206 (91%) in, group n: (p=ns). The mean tra nsmitral gradient decreased from 24.8+/-7.6 mmHg to 7.46+/-3.4 mmHg while m ean PCWP fell from 27.5+/-7.3 mmHg to 12.2+/-5.6 mmHg and MPAP fell from 46 .3+/-16.9 mmHg to 23.6+/-12.2 mmHg (p=<0.001). MVA increased from 0.7+/-0.2 cm2 to 1.7+/-0.4 cm(2) (p=<0.001). Severe mitral regurgitation (MR) occurr ed in 2 patients out of which one patient, who had associated coronary arte ry disease, died post operatively, and moderate MR occurred in 8 patients. The results achieved in patients with severe SVP were not statistically dif ferent from those with mild/moderate SVP. The benefits achieved immediate p ost IBMV were sustained in 184 patients with severe SVP who were available for follow up at a mean duration of 15.2 months (range 3 months to 51 month s). Thus IBMV is safe and effective in patients with severe SVP. This group of patients with severe SVP are more hemodynamically deranged pre-BMV and also achieve better hemodynamic benefit compared to those with mild/moderat e SVP. Severe SVP does not have any adverse effect either on immediate resu lts (success/occurrence of MR) or on intermediate term follow up. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.