Mechanisms and predictors of transient left ventricular dysfunction early after successful percutaneous balloon mitral valvuloplasty.
BACKGROUND
The immediate effects of balloon mitral valvuloplasty (BMV) on left ventricular (LV) function in patients with mitral stenosis are still controversial. The aim of this study was to investigate the mechanisms and potential clinical, echocardiographic and hemodynamic predictors of transient LV dysfunction occurring in patients with mitral stenosis early after successful percutaneous BMV.


METHODS
Sixty patients without residual mitral regurgitation were divided into two groups according to the changes in the left atrial (LA) pressure 15 min after successful BMV: 18 patients (group A) did not present with any reduction in LA pressure, and underwent nitroglycerin administration (0.4 mg, sublingually). The remaining 42 patients (group B) presented with a decrease in LA pressure.


RESULTS
At baseline, both the mitral valve gradient and area assessed at echocardiography and during cardiac catheterization were similar in groups A and B. Group A patients presented with, however, higher LV early- and end-diastolic pressures and peak V waves during cardiac catheterization both prior to and 15 min after BMV than group B patients (all p values < 0.05). In group A, nitroglycerin administration was associated with a decrease in LV end-diastolic pressure (p = 0.049), LA pressure (p < 0.001), and peak V wave (p < 0.001) that was still persistent 30 min after its administration, reaching values similar to those observed in group B early after BMV. At multivariate analysis, the only independent predictors of LV dysfunction early after BMV were found to be LV early- (p = 0.015) and end-diastolic (p = 0.023) pressures at baseline and the Wilkins' score (p = 0.004).


CONCLUSIONS
After successful BMV a transient lack of LV adaptation to the increased LV preload resulting in a persistently elevated LA pressure is predicted by higher baseline LV diastolic filling pressures and higher Wilkins' scores. It is promptly and steadily reversed by nitroglycerin administration through a transient LV unloading, thus allowing a correct hemodynamic evaluation of the immediate results of the procedure.
Tomai
Fabrizio
F
Catheterization Laboratory, Division of Cardiac Surgery, Tor Vergata University, Rome, Italy. f.tomai@tiscali.it
Polisca
Patrizio
P
Ghini
Anna S
AS
Gaspardone
Achille
A
Versaci
Francesco
F
Furgeri
Alessandro
A
Proietti
Igino
I
Gioffrè
Gaetano
G
Crea
Filippo
F
Chiariello
Luigi
L
Gioffrè
Pier A
PA
D000704:Analysis of Variance; D016279:Atrial Function, Left; D002404:Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D017725:Ventricular Pressure