title: Clinical significance of small left-to-right shunts after percutaneous mitral valvuloplasty.
abstract: Left-to-right shunt after percutaneous mitral valvuloplasty was evaluated by contrast echocardiography in 29 patients at 24 hours and at 1, 3, 6, and 9 months after the procedure. The patients were divided into two groups: in group A (13 patients) the double-balloon technique was used; in group B (16 patients) the Inoue single-balloon technique was used. The two groups were comparable in terms of age, gender, and mitral valve area before and after percutaneous mitral valvuloplasty. A left-to-right shunt was detected in all patients 24 hours after the procedure. At 1 month follow-up the shunt was present in 12 patients of group A (92%) and in 13 of group B (81%) with a statistically significant difference (p < 0.001). At 3 months the values were 7 (54%) in group A and 6 (37.5%) in group B (p < 0.05); at 6 months the values were 3 (23%) in group A and 3 (19%) in group B (NS). At 9 months a left-to-right shunt was no longer detectable in any of the patients in either group. The disappearance of the shunt could be related to a healing process of the atrial septal injury that occurs within a few months after percutaneous mitral valvuloplasty. This process seems to be more rapid in group B patients, probably because of the smaller lesion that is produced in the atrial septum by the passage of the Inoue balloon.
authors.affiliation: Istituto di Chirurgia del Cuore, Università La Sapienza, Roma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nigri
authors.forename: N
authors.initials: N
authors.lastname: Alessandri
authors.forename: E
authors.initials: E
authors.lastname: Martuscelli
authors.forename: E
authors.initials: E
authors.lastname: Mangieri
authors.forename: A
authors.initials: A
authors.lastname: Berni
authors.forename: F
authors.initials: F
authors.lastname: Comito
mesh_terms: D000328:Adult; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006346:Heart Septum / Q000293:injuries*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013997:Time Factors