Initial Results and Long-Term Follow-up of Percutaneous Mitral Valvuloplasty in Patients with Pulmonary Hypertension

详细信息    查看全文

• 作者：Ricardo A. Sarmiento ; MD ; FACC^a ; ^b ; Rodrigo Blanco ; MD^a ; ^c ; Gerardo Gigena ; MD^a ; Jorge Lax ; MD^a ; Alejandro Garcia Escudero ; MD^a ; ^c ; Federico Blanco ; MD^a ; ^c ; Jorge Szarfer ; MD^a ; Raul Solerno ; MD^b ; Carlos D. Tajer ; MD ; FACC^b ; Juan A. Gagliardi ; MD ; PhD^a ; ^{jgagliardi@intramed.net}
• 关键词：Valvuloplasty ; Mitral valve stenosis ; Haemodynamics ; Pulmonary hypertension
• 刊名：Heart, Lung and Circulation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：26
• 期：1
• 页码：58-63
• 全文大小：640 K
• 卷排序：26

文摘

Percutaneous balloon mitral valvuloplasty (PMV) is an attractive therapeutic approach in patients with mitral stenosis. The aim of this study was to assess the immediate and long-term clinical, echocardiographic and haemodynamic outcomes of PMV in patients with severe pulmonary hypertension (PAH).MethodsPercutaneous balloon mitral valvuloplasty was performed in 157 consecutive patients; 60 patients (38.2%) had significant PAH defined as baseline pulmonary artery mean pressure (PAMP) ≥ 30 mm Hg (Group 1) and 97 patients (61.8%) had PAMP ≤ 30 mmHg (Group 2).Pulmonary artery systolic pressure (PASP), mortality, need for mitral valve replacement or new PMV, and valve restenosis were evaluated during follow-up.ResultsMean age was 44.2 years and 88.5% (139 patients) were women. Primary success was achieved in 79.6% of the patients (125 patients) without differences between the groups.Mitral valve area increased from 0.90 cm2 to 1.76 cm2, PASP fell from 57 mmHg to 35 mmHg in Group 1 and from 38 mmHg to 30 mmHg in Group 2.Median PASP in Group 1 was 35, 32, 36, 38 and 34 mmHg at 12, 24, 36, 48 and 60 months. There were no significant differences in mitral valve area, PASP and clinical status between the groups.ConclusionPercutaneous balloon mitral valvuloplasty is a safe and effective technique for the treatment of patients with mitral stenosis and PAH. A significant decrease in pulmonary pressure was observed after valvuloplasty. Although there was a gradual decrease of MVA at long-term follow-up, most patients remained asymptomatic and PASP was stable.