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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016
AFRICA
149
Echocardiographic and catheterisation assessment of patients
before the procedure showed no significant differences between
the basic features of the two groups. The degree of mitral valve
stenosis, mitral valve scores and MR (2
+
) were similar between
the two groups (
p
=
0.73,
p
=
0.58 and
p
=
0.74, respectively).
BMVs were performed successfully on both groups. Adequate
mitral valve area and a decrease in MVG were obtained.
BMV was assessed as successful in 60 (92.3%) patients in the
HBRS group and in 61 (96.8%) in the EBRS group (
p
=
0.03). The
mean of the calculated balloon reference sizes was significantly
higher in the HBRS than in the EBRS group [26.3
±
1.2 mm, 95%
confidence interval (CI): 26.1–26.6 vs 25.2
±
1.1, 95% CI: 25.0–
25.4, respectively;
p
=
0.007]. The final inflated balloon sizes were
similar between the groups (25.6
±
0.9 mm, 95% CI: 25.3–25.9
vs 25.9 mm
±
1.0 mm, 95% CI: 25.1–25.8, respectively;
p
=
0.34).
The post-procedural results of the patients are presented in
Table 4. A greater decrease in the trans-mitral mean gradient
was observed in the EBRS group but it was not statistically
significant (
p
=
0.06). In the EBRS group, larger MVAs were
achieved than in the HBRS group (1.6
±
0.3 cm
2
, 95% CI:
1.56–1.69 vs 1.7
±
0.3 cm
2
, 95% CI: 1.57–1.74, respectively;
p
=
0.02). The incidence of significant MR (3–4
+
) was lower than
in the HBRS group (
p
=
0.05 by echocardiography and
p
=
0.03
by ventriculography). Also, 2
+
degree MR was significantly less
developed in the EBRS patients (
p
=
0.01).
Discussion
In recent years, Inoue balloon mitral commissurotomy has
become the treatment of choice in many patients with rheumatic
mitral stenosis. The main target of this procedure is to resolve
the stenotic mitral orifice without causing extensive damage
to the commissures, leaflets and subvalvular apparatus, thus
leading to excessive mitral regurgitation. The most common
serious complication is haemopericardium, with an incidence
of 0 to 2.0%.
17
Severe MR is another important and common
serious complication after BMV.
18
Many studies have shown that acute procedural results,
including final MVA and post-procedural MR, independently
predict the long-term outcome after BMV.
8
When severe mitral
regurgitation occurs after BMV, surgical treatment is required at
some point. Most mild but significant cases of MR are caused by
commissural split, chordal rupture or leaflet laceration.
Table 1. Background characteristics of study patients
HBRS
(
n
=
65)
EBRS
(
n
=
63)
p-
value
Age (years)
35.4
±
6.2
31.4
±
5.1
0.12
Gender,
n
(%)
Male
18 (27.7)
17 (27)
0.67
Female
47 (72.3)
46 (73)
0.58
Weight (kg)
66.2
±
10.9
70.1
±
11.1
0.14
Height (cm)
162
±
9
163
±
9
0.62
CVD
3
1
0.09
Atrial fibrillation
14
12
0.53
NYHA
1
16
12
0.62
2
41
42
3
8
9
EBRS, echocardiographic balloon reference sizing; HBRS, height-based balloon
reference sizing; F, female; M, male; CVD, cerebrovascular disease; NYHA,
New York Heart Association functional classification.
Table 2. Pre-procedural echocardiographic
data of study participants
HBRS
(
n
=
65)
EBRS
(
n
=
63)
p-
value
LVDD (mm)
46
±
2.4
47
±
2.5
0.81
LVSD (mm)
29
±
1.5
29
±
1.4
0.78
LA (mm)
49
±
6
47
±
6
0.51
LVEF (%)
64
±
5
65
±
5
0.54
MVA (cm
2
)
1.1
±
0.2
1.0
±
0.3
0.13
MV Wilkins score
8.7
±
1.1
9.1
±
1.4
0.38
MV max gradient (mmHg)
22.4
±
5.5
21
±
5.3
0.34
MV mean gradient (mmHg)
9.5
±
4.2
9.7
±
4.5
0.69
MR
0
20
19
0.52
1
+
42
39
2
+
3
5
EBRS, echocardiographic balloon reference sizing; HBRS, height-based balloon
reference sizing; LVDD, left ventricular end-diastolic diameter; LVSD, left
ventricular end-systolic diameter; LA, left atrium; LV EF, left ventricular ejec-
tion fraction; MVA, mitral valve area; MV, mitral valve; MR, mitral regurgita-
tion.
Table 3. Pre-procedural catheterisation
data of study participants
HBRS
(
n
=
65)
EBRS
(
n
=
63)
p-
value
PA pressure (mmHg)
49
±
15
51
±
16
0.91
RV pressure (mmHg)
48
±
14
49
±
15
0.82
RA pressure (mmHg)
7.5
±
2
9.1
±
2.4
0.14
MV mean pressure (mmHg)
9.9
±
4.1
10.4
±
4.4
0.32
MR
0
21
20
0.69
1
+
41
39
2
+
3
4
EBRS, echocardiographic balloon reference sizing; HBRS, height-based balloon
reference sizing; PA, pulmonary artery; RV, right ventricle; RA, right atrium;
MV, mitral valve; MR, mitral regurgitation.
Table 4. Post-procedural catheterisation
data of study participants
HBRS
(
n
=
65)
EBRS
(
n
=
63)
p-
value
Estimated reference MBS (mm)
26.3
±
1.2 25.2
±
1.1
0.02
Final balloon size
25.6
±
0.9 25.9
±
1.0
0.34
MVA (cm
2
)
1.6
±
0.2 1.7
±
0.3 0.02
Transmitral mean gradient (mm Hg)
3.2
±
0.3 3.0
±
0.3 0.04
PAP (mmHg)
28
±
8
29
±
7
0.81
MR severity,
n
(%)
Echocardiography
0
10
14
0.03
1
+
41
43
2
+
11
5
3–4
+
3
1
Catheterisation
0
9
13
0.04
1
+
39
42
2
+
13
6
3–4
+
4
2
EBRS, echocardiographic balloon reference sizing; HBRS, height-based balloon
reference sizing; MBS, mitral balloon size; MVA, mitral valve area; PAP, pulmo-
nary artery pressure; MR, mitral regurgitation.