Echocardiography can predict the development of severe mitral regurgitation after percutaneous mitral valvuloplasty by the Inoue technique

Severe mitral regurgitation (MR) following mitral balloon valvuloplasty is a major complication of this procedure. We recently described a new echocar diographic score that can predict the development of severe MR following mi tral valvuloplasty with the double balloon technique. The present study was designed to test the usefulness of this score for predicting severe MR in patients undergoing the procedure using the Inoue balloon technique, From 1 17 consecutive patients who underwent mitral valvuloplasty using the Inoue technique, 14 (11.9%) developed sever MR after the procedure. A good qualit y echocardiogram before mitral valvuloplasty was available in 11 patients. These 11 patients were matched by age, sex, mitral valve area, and degree o f MR before valvuloplasty with 69 randomly selected patients who did not de velop severe MR after Inoue valvuloplasty. The total MR-echocardiographic ( MR-echo) score was significantly greater in the severe MR group (10.5 +/- 1 .4 vs 8.2 +/- 1.1; p <0.001). In addition, the component grades for the ant erior leaflet (2.9 +/- 0.5 vs 2.2 +/- 0.4; p <0.001), posterior leaflet (2. 6 +/- 0.7 vs 1.9 +/- 0.8), commissures (2.4 +/- 0.8 vs 2.0 +/- 0.5; p <0.05 ) and subvalvular apparatus (2.6 +/- 0.5 vs 1.9 +/- 0.4; p <0.001) were als o higher in the MR group. Using a total score of greater than or equal to 1 0 as a cut-oft point for predicting severe MR with the Inoue technique, a s ensitivity of 82%, specificity of 91%, accuracy of 90%, and negative predic tive value of 97% were obtained. Stepwise logistic regression analysis iden tified the MR-echo score as the only independent predictor for developing s evere MR with the Inoue technique (p <0.0001). Thus, the MR-echo score can also predict the development of: severe MR Following mitral balloon valvulo plasty using the Inoue technique, (C) 1999 by Excerpta Medica, Inc.