EMERGENT BALLOON MITRAL VALVOTOMY IN PATIENTS PRESENTING WITH CARDIAC-ARREST, CARDIOGENIC-SHOCK OR REFRACTORY PULMONARY-EDEMA

Objectives. The present study was performed to determine the outcome o f emergent balloon mitral valvotomy (BMV) in patients with cardiac arr est, pulmonary edema or cardiogenic shock. Background. In India, many patients with mitral stenosis present in critical condition. They have high mortality despite surgical relief. The role of BMV in such patie nts is ill-defined. Methods. Of 558 patients undergoing BMV between Ja nuary 1993 and December 1994, 40 presented with cardiogenic shock, car diac arrest or pulmonary edema refractory to medical treatment and und erwent emergent BMV (group I). Elective BMV was performed in the remai ning 518 patients (group II). Results. Age ([mean +/- SD] 40 +/- 13 vs . 31 +/- 9 years, p < 0.05), incidence of atrial fibrillation (35% vs. 11%, p < 0.05), pulmonary artery systolic pressure (PAsP) (63 +/- 14 vs. 51 +/- 12 mm Hg, p < 0.001) and mitral valve (MV) score (7.4 +/- 1 .2 vs. 6.4 +/- 1, p < 0.001) mere higher and MV area lower (0.74 +/- 0 .17 vs. 0.86 +/- 0.14 cm(2), p < 0.001) in group I patients. After eme rgent BMV in group I, mitral regurgitation occurred in 15%, and the mo rtality rate mas 35%. Step,vise logistic regression analysis identifie d MV score greater than or equal to 8 (p = 0.008), PAsP greater than o r equal to 65 mm Hg (p = 0.023) and cardiac output less than or equal to 3.151 liters/min (p = 0.001) as significant predictors of a fatal o utcome. Follow-up of 1 to 16 months (median 8) was available in 20 of 26 survivors in group I, of whom 15 were asymptomatic. The gain in MV area and the decrease in transmitral gradient and PAsP obtained immedi ately after BMV persisted during the follow-up period. Conclusions. Em ergent BMV is feasible in critically ill patients. In-hospital survivo rs have excellent clinical and hemodynamic status at intermediate foll ow-up. (C) 1998 by the American College of Cardiology.