title: Significance of commissural calcification on outcome of mitral balloon valvotomy.
abstract: OBJECTIVE
  To evaluate the significance of commissural calcification, identified by transthoracic echocardiography, on the haemodynamic and symptomatic outcome of mitral balloon valvotomy.
  
  
  METHODS
  Commissural calcification was graded from 0-4 using parasternal short axis transthoracic views. The morphology of the mitral valve was also assessed using the Massachusetts General Hospital echo score.
  
  
  METHODS
  A tertiary cardiac centre in Scotland.
  
  
  METHODS
  300 patients were studied, 85 retrospectively and 215 prospectively. Mean (SD) age was 59.8 (12.7) years, range 13 to 87; 30% had been judged unsuitable for surgery. Median echo score was 6.8 (3.0), range 2-16.
  
  
  METHODS
  Immediate increase in mitral valve area and in New York Heart Association functional class 1-3 months after balloon valvotomy.
  
  
  RESULTS
  On univariate and multivariate analysis, commissural calcification grade was a significant predictor of achieving a mitral valve area of > 1.50 cm(2) without severe mitral reflux. Its influence was greatest in patients with an echo score </= 8: those with commissural calcification grade 0/1 had significantly greater improvement in valve area and symptom status than those with grade 2/3; the proportions of patients achieving a final valve area of > 1.50 cm(2) were 67% and 46%, respectively (p < 0.05). In patients with an echo score of > 8, the influence of commissural calcification was smaller and not significant.
  
  
  CONCLUSIONS
  Commissural calcification as assessed by transthoracic echocardiography is a useful predictor of outcome in patients with otherwise "good" valves (echo score </= 8). Calcification of one commissure or more predicts a less than 50% probability of achieving a valve area above 1.50 cm(2) and is an indication for valve replacement in those who are suitable for surgery.
authors.affiliation: Department of Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
authors.forename: N
authors.initials: N
authors.lastname: Sutaria
authors.forename: D B
authors.initials: DB
authors.lastname: Northridge
authors.forename: T R
authors.initials: TR
authors.lastname: Shaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D008944:Mitral Valve Insufficiency / Q000517:prevention & control; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome