title: Predictors of unsuccessful outcome after percutaneous mitral valvulotomy including a new echocardiographic scoring system.
abstract: OBJECTIVE
  Percutaneous mitral valvulotomy has been shown to be an accept able alternative to surgery as treatment for selected patients with severe mitral stenosis. Uncertainty still exists regarding predictors of unsuccessful outcome.
  
  
  METHODS
  308 patients with severe mitral stenosis underwent Inoue single balloon valvulotomy over a 48-month period and were followed up for a mean of 14.5 +/- 16.8 months (range one to 64 months). Two hundred and sixty-seven (Group I) improved clinically and remained stable throughout the follow up, while subsequent surgery was required in 41 (Group II) after 38.2 +/- 143.5 days (range one to 1,212). Clinical and echocardiographic parameters of the two groups were compared to find significant predictors of an unsuccessful outcome.
  
  
  RESULTS
  Significant differences between the groups were observed for NYHA class (2.7 +/- 0.6 vs. 2.9 +/- 0.6, p < 0.05), mitral valve area (1.0 +/- 0.3 vs. 0.9 +/- 0.2 cm2, p < 0.01), left atrial end-systolic dimension by echo (51.3 +/- 8.0 vs. 55.4 +/- 10.2 mm, p < 0.01) and an echocardiographic scoring system including grading for eccentricity of the mitral orifice and distribution of commissural calcification (7.5 +/- 2.0 for Group I and 8.7 +/- 2.0 for Group II, p < 0.001).
  
  
  CONCLUSIONS
  Mitral valves that are more likely to have an unsuccessful outcome can be identified by hemodynamic, clinical and echocardiographic criteria, including grading for eccentricity of the mitral orifice and distribution of commissural calcification.
authors.affiliation: Department of Cardiology, Herzzentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Miche
authors.forename: N
authors.initials: N
authors.lastname: Bogunovic
authors.forename: D
authors.initials: D
authors.lastname: Fassbender
authors.forename: D
authors.initials: D
authors.lastname: Baller
authors.forename: U
authors.initials: U
authors.lastname: Gleichmann
authors.forename: H
authors.initials: H
authors.lastname: Mannebach
authors.forename: H P
authors.initials: HP
authors.lastname: Terwesten
authors.forename: H
authors.initials: H
authors.lastname: Schmidt
authors.forename: K
authors.initials: K
authors.lastname: Minami
authors.forename: N
authors.initials: N
authors.lastname: Mirow
authors.forename: J
authors.initials: J
authors.lastname: Vogt
authors.forename: R
authors.initials: R
authors.lastname: Körfer
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis; D002404:Catheterization; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology; D008946:Mitral Valve Stenosis / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*