COMPARISON OF LATE RESULTS OF BALLOON VALVOTOMY IN MITRAL-STENOSIS WITH VERSUS WITHOUT MITRAL REGURGITATION

Balloon mitral valvotomy (BMV) is safe and effective in patients with mitral stenosis (MS) and coexisting mild mitral regurgitation (MR). In fluence of preexisting MR on late outcome of BMV is under evaluation. We included 77 patients without MR and 72 with MR in this study, and c ompared their immediate and late results in a mean follow-vp of 33 +/- 24 months after BMV. Patients with coexisting MR were older and more frequently had significant valvular calcium and atrial fibrillation th an patients without MR. After BMV, mitral valve gradient decreased, an d cardiac output and mitral valve area by planimetry increased signifi cantly (all p = 0.0001) in both groups. There was no difference in val ues of mitral valve gradient and cardiac output after BMV between the groups. Mitral valve area was significantly smaller in patients with p reexisting MR. During follow-up, there were 11 patients (14%) in the g roup without MR and 24 (33%) in the group with MR developed cardiac ev ents (p = 0.006). Cumulative event-free survival was 90% at the second year, 87% at the fourth year, and 69% at the sixth year, respectively , in the group without MR versus 78%, 62%, and 37%, respectively, in t he group with MR (p = 0.0014). Cox regression showed that preexisting MR was a significant predictor for late cardiac events with a threefol d increased hazard risk (p = 0.0025), but age, valvular calcium, echoc ardiographic score, and cardiac rhythm also played a culpable role. We conclude that preexisting MR is an important risk factor for poor, la te outcome of BMV. (C) 1998 by Excerpta Medica, Inc.