PMID- 1537133
OWN - NLM
STAT- MEDLINE
DCOM- 19920327
LR  - 20190623
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 85
IP  - 3
DP  - 1992 Mar
TI  - Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 
      years and older.
PG  - 963-71
AB  - BACKGROUND: We analyzed the immediate and long-term outcome of percutaneous 
      balloon mitral valvotomy (PMV) in 99 patients who were greater than or equal to 
      65 years of age (81 women and 18 men; mean +/- SEM age, 72 +/- 0.5 years). 
      METHODS AND RESULTS: There were 84 patients in New York Heart Association (NYHA) 
      class III or IV; 26 patients had previous surgical commissurotomy; 64 had one or 
      more comorbidities; 73 had fluoroscopically visible mitral valve (MV) 
      calcification; and 63 had echocardiographic score greater than 8 (mean +/- SEM 
      score, 9.2 +/- 0.2). There were three procedural deaths, all occurring in our 
      early experience. Pericardial tamponade occurred in five patients, 
      thromboembolism in three, and transient atrioventricular block in one. After PMV, 
      MV area was greater than or equal to 1 cm2 in 86 patients and greater than or 
      equal to 1.5 cm2 in 56. A successful outcome (defined as MV area greater than or 
      equal to 1.5 cm2 without a greater than or equal to 2-grade increase in mitral 
      regurgitation and without left-to-right shunt with a pulmonary-to-systemic flow 
      ratio of greater than or equal to 1.5:1) was achieved in 46 patients. The best 
      multivariate predictor of success was the combination of echocardiographic score, 
      NYHA functional class, and inverse of MV area. Mean follow-up was 16 +/- 1 
      months. Actuarial survival (79 +/- 7% versus 62 +/- 10%, p = 0.04), survival 
      without MV replacement (71 +/- 8% versus 41 +/- 8%, p = 0.002), and survival 
      without MV replacement and NYHA class III or IV (54 +/- 12% versus 38 +/- 8%, p = 
      0.01) at 3 years were significantly better in the successful group of 46 patients 
      than in the unsuccessful group of 53 patients. Low echocardiographic score was 
      the only independent predictor of survival. Lack of MV calcification and low NYHA 
      class, low mean left atrial pressure, and low pulmonary artery pressure were the 
      independent predictors of event-free survival. CONCLUSIONS: PMV can be performed 
      safely in selected patients greater than or equal to 65 years old with good 
      immediate and long-term results. In addition to clinical examination, 
      echocardiographic evaluation of the mitral valve and fluoroscopic screening for 
      valvular calcification are the most important steps in patient selection for 
      successful outcome.
FAU - Tuzcu, E M
AU  - Tuzcu EM
AD  - Department of Medicine (Cardiac Unit), Massachusetts General Hospital, Harvard 
      Medical School, Boston 02114.
FAU - Block, P C
AU  - Block PC
FAU - Griffin, B P
AU  - Griffin BP
FAU - Newell, J B
AU  - Newell JB
FAU - Palacios, I F
AU  - Palacios IF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Actuarial Analysis
MH  - Aged
MH  - *Balloon Occlusion
MH  - *Catheterization
MH  - Comorbidity
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Mitral Valve Stenosis/diagnostic imaging/mortality/*therapy
MH  - Regression Analysis
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 1992/03/01 00:00
MHDA- 1992/03/01 00:01
CRDT- 1992/03/01 00:00
PHST- 1992/03/01 00:00 [pubmed]
PHST- 1992/03/01 00:01 [medline]
PHST- 1992/03/01 00:00 [entrez]
AID - 10.1161/01.cir.85.3.963 [doi]
PST - ppublish
SO  - Circulation. 1992 Mar;85(3):963-71. doi: 10.1161/01.cir.85.3.963.