PMID- 19356525
OWN - NLM
STAT- MEDLINE
DCOM- 20090702
LR  - 20161125
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 2
IP  - 1
DP  - 2009 Jan
TI  - Impact of degree of commissural opening after percutaneous mitral commissurotomy 
      on long-term outcome.
PG  - 1-7
LID - 10.1016/j.jcmg.2008.10.002 [doi]
AB  - OBJECTIVES: We sought to evaluate the prognostic value of the degree of 
      commissural opening (CO) on outcome. BACKGROUND: Commissural opening is the main 
      mechanism by which the mitral valve area (MVA) increases after percutaneous 
      mitral commissurotomy (PMC) but its impact on long-term outcome has never been 
      evaluated. METHODS: Of 1,024 consecutive patients with severe MS who underwent 
      PMC, degree of CO was prospectively evaluated in 875 patients (age 48 +/- 13 
      years, female 83%, New York Heart Association (NYHA) functional class III/IV 75%) 
      with good immediate PMC results (MVA >or=1.5 cm(2) and no mitral regurgitation 
      >2/4). These 875 patients were divided into 3 groups: both commissures only 
      partially opened or not split (Group 1, n = 189), 1 commissure completely split 
      (Group 2; n = 459), and both commissures completely split (Group 3; n = 227). 
      During a follow-up of 55 +/- 28 months, following clinical end points were 
      collected: death, cardiovascular death, need for mitral valve surgery or repeat 
      dilation, and NYHA functional class. RESULTS: Before PMC, patients in Group 1 
      were older, more often in NYHA functional class III/IV, but MVA and mean gradient 
      were not different (p >or= 0.50). Immediately after PMC, there were significant 
      differences between groups with regard to mean gradient (Group 1, 5.1 +/- 2.1 mm 
      Hg; Group 2, 4.5 +/- 1.7 mm Hg; Group 3, 4.0 +/- 1.6 mm Hg; p < 0.0001) and MVA 
      (Group 1, 1.8 +/- 0.2 cm(2); Group 2, 1.9 +/- 0.2 cm(2); Group 3, 2.1 +/- 0.3 
      cm(2); p < 0.0001). The 10-year rate of good functional results (survival without 
      need for mitral surgery or repeat dilation and NYHA functional class I or II at 
      last follow-up) was significantly higher in Group 3 (76 +/- 5%) than in Groups 1 
      and 2 (39 +/- 8% and 57 +/- 11%, respectively; p < 0.0001). In multivariable 
      analysis, either the degree of CO or the MVA was an independent predictor of good 
      late functional results (p < 0.05). CONCLUSIONS: Complete CO is associated with 
      larger MVA, smaller gradients, and functional improvement. The degree of CO 
      provides important prognostic information and thus should be systematically 
      evaluated during and after PMC and considered as a complementary measure of the 
      procedural success in addition to the MVA, not always easy to assess.
FAU - Messika-Zeitoun, David
AU  - Messika-Zeitoun D
AD  - AP-HP, Cardiology Department, Bichat Hospital, Paris, France. 
      david.messika-zeitoun@bch.aphp.fr
FAU - Blanc, Julie
AU  - Blanc J
FAU - Iung, Bernard
AU  - Iung B
FAU - Brochet, Eric
AU  - Brochet E
FAU - Cormier, Bertrand
AU  - Cormier B
FAU - Himbert, Dominique
AU  - Himbert D
FAU - Vahanian, Alec
AU  - Vahanian A
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
SB  - IM
CIN - JACC Cardiovasc Imaging. 2009 Jan;2(1):8-10. PMID: 19356526
CIN - JACC Cardiovasc Imaging. 2009 Aug;2(8):1034-5; author reply 1035-6. PMID: 
      19679293
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Cardiac Catheterization/adverse effects
MH  - Cardiac Surgical Procedures
MH  - *Catheterization/adverse effects
MH  - Echocardiography, Doppler
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Stenosis/diagnostic imaging/mortality/*therapy
MH  - Patient Selection
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2009/04/10 09:00
MHDA- 2009/07/03 09:00
CRDT- 2009/04/10 09:00
PHST- 2008/06/06 00:00 [received]
PHST- 2008/10/14 00:00 [revised]
PHST- 2008/10/16 00:00 [accepted]
PHST- 2009/04/10 09:00 [entrez]
PHST- 2009/04/10 09:00 [pubmed]
PHST- 2009/07/03 09:00 [medline]
AID - S1936-878X(08)00406-3 [pii]
AID - 10.1016/j.jcmg.2008.10.002 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2009 Jan;2(1):1-7. doi: 10.1016/j.jcmg.2008.10.002.