title: Gross echocardiographic underestimation of mitral valve calcification--a near fatal experience.
abstract: Acute severe mitral regurgitation is a feared complication following percutaneous balloon mitral valvuloplasty (PBMV) for the treatment of severe mitral stenosis, contributing to the 1% peri-procedural mortality rate of this procedure. Whilst there is an extensive experience with the use of the Wilkins echocardiographic score to assess patient suitability and predict long-term clinical outcomes following PBMV, catastrophic severe acute mitral regurgitation, such as that described in our patient, is a remarkably rare occurrence following PBMV in patients with favourable Wilkins echocardiographic criteria. We highlight a case of the gross underestimation of the degree of valvular calcification using trans-oesophageal echocardiography, when compared to the findings at surgery, which contributed to our patients' life-threatening mitral regurgitation following the first balloon inflation. We advocate further research into the utility of multi-detector computed tomography (MDCT) imaging for the adjunctive pre-procedural assessment of the degree mitral calcification in order to further minimise the risk of peri-procedural complications associated with PBMV. This would be particularly suitable in the elderly population who normally have greater degrees of valvular calcification that may be underestimated with echocardiography alone.
authors.forename: R
authors.initials: R
authors.lastname: Puri
authors.forename: B K
authors.initials: BK
authors.lastname: Dundon
authors.forename: S
authors.initials: S
authors.lastname: Khurana
authors.forename: M I
authors.initials: MI
authors.lastname: Worthley
authors.forename: J
authors.initials: J
authors.lastname: Edwards
authors.forename: S G
authors.initials: SG
authors.lastname: Worthley
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D017548:Echocardiography, Transesophageal / Q000592:standards*; D005260:Female; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D015203:Reproducibility of Results; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000601:surgery