The impact of mitral valve morphology on the long-term outcome of mitral balloon valvuloplasty.
BACKGROUND
The effect of mitral valve morphology (MVM) on the long-term results of mitral balloon valvuloplasty (MBV) is not well established. The aim of the study was to evaluate the impact of MVM on long-term outcome of MBV.


METHODS
Five hundred and eighteen consecutive patients (mean age, 31+/-11 years) who underwent successful MBV were followed up for 0.5-16.5 (mean, 6+/-4.5) years. Patients were divided into two groups according to their mitral echo score (MES) before MBV: group A (n=340; MES<or=8) and group B (n=178; MES>8).


RESULTS
We report the immediate and long-term clinical and echocardiographic results of the above-mentioned 518 consecutive patients. The mitral valve area was significantly larger in group A than in group B, both immediately after MBV (2.0+/-0.3 vs. 1.82+/-0.3 cm2, respectively; P<0.0001) and also at the last follow-up (1.8+/-0.33 vs. 1.5+/-0.33 cm2, respectively; P<0.0001). Restenosis occurred in 38/340 (11%) in group A vs. 73/178 (41%) in group B (P<0.0001). Actuarial freedom from restenosis at 5, 10, 15 years were 92+/-2%, 85+/-3%, 65+/-6% for group A vs. 72+/-4%, 44+/-5%, 9+/-6% for group B (P<0.001). Event-free survival rates at 5, 10, 15 years for group A were 93+/-1%, 88+/-2%, 66+/-6% vs. 82+/-3%, 59+/-6%, 8+/-7% for group B (P<0.0001). Stepwise Cox multivariate regression analysis identified MES, preprocedure functional class, and postprocedure mitral valve area<or=1.8 cm2, as predictors of restenosis (P<0.0001, P=0.014, P=0.0015, respectively); MES and age as predictors of event-free survival (P<0.0001, P<0.0001, respectively).


CONCLUSIONS
MBV has excellent long-term results in patients with favorable MVM. Favourable MVM is a strong predictor of good long-term outcome.
Fawzy
Mohamed Eid
ME
Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. fawzy100@hotmail.com
Shoukri
Mohamed
M
Hassan
Walid
W
Nambiar
Vijayaraghavan
V
Stefadouros
Miltiadis
M
Canver
Charles C
CC
D000328:Adult; D002404:Catheterization / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000473:pathology; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome