Elsevier

JACC: Cardiovascular Imaging

Volume 13, Issue 12, December 2020, Pages 2513-2526
JACC: Cardiovascular Imaging

Original Research
Mitral Regurgitation After Percutaneous Mitral Valvuloplasty: Insights Into Mechanisms and Impact on Clinical Outcomes

https://doi.org/10.1016/j.jcmg.2020.07.020Get rights and content
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Abstract

Objectives

The aim of this study was to assess the incidence, mechanisms, and outcomes of mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV).

Background

Significant MR continues to be a major complication of PMV, with a wide range in clinical presentation and prognosis.

Methods

Consecutive patients with mitral stenosis undergoing PMV were prospectively enrolled. MR severity was evaluated by using quantitative echocardiographic criteria, and its mechanism was characterized by 3-dimensional transesophageal echocardiography, divided broadly into 4 categories based on the features contributing to the valve damage. B-type natriuretic peptide levels were obtained before and 24 h after the procedure. Endpoints estimated cardiovascular death or mitral valve (MV) replacement due to predominant MR.

Results

A total of 344 patients, ages 45.1 ± 12.1 years, of whom 293 (85%) were women, were enrolled. Significant MR after PMV was found in 64 patients (18.6%). The most frequent mechanism of MR was commissural, which occurred in 22 (34.4%) patients, followed by commissural with posterior leaflet in 16 (25.0%), leaflets at central scallop or subvalvular damage in 15 (23.4%), and central MR in 11 (17.2%). During the mean follow-up period of 3 years (range 1 day to 10.6 years), 60 patients reached the endpoint. The event-free survival rates were similar among patients with mild or commissural MR, whereas patients with damaged central leaflet scallop or subvalvular apparatus had the worst outcome, with an event-free survival rate at 1 year of only 7%. Long-term outcome was predicted by net atrioventricular compliance (Cn) at baseline and post-procedural variables, including valve area, mean gradient, and magnitude of decrease in B-type natriuretic peptide levels, adjusted for the mechanism of MR.

Conclusions

Significant MR following PMV is a frequent event, mainly related to commissural splitting, with favorable clinical outcome. Parameters that express the relief of valve obstruction and the mechanism by which MR develops were predictors of long-term outcomes.

Key Words

mitral regurgitation
mitral stenosis
outcomes
percutaneous mitral valvuloplasty

Abbreviations and Acronyms

2D
2-dimensional
3D
3-dimensional
BNP
B-type natriuretic peptide
Cn
net atrioventricular compliance
MR
mitral regurgitation
MS
mitral stenosis
MV
mitral valve
MVR
mitral valve replacement
PMV
percutaneous mitral valvuloplasty
TEE
transesophageal echocardiography

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