title: [The efficiency and safety of balloon valvuloplasty in patients with mitral stenosis and a high echo score: mid- and short-term clinical and echocardiographic results].
abstract: OBJECTIVE
  We aimed to evaluate the success and safety of percutaneous mitral balloon valvuloplasty (PMBV) and its mid-term clinical and echocardiographic results in patients with symptomatic mitral stenosis, including those having a high echo score (9 to 11).
  
  
  METHODS
  This prospective study included 57 consecutive patients (9 men, 48 women; mean age 41+/-9 years) who underwent PMBV with the Inoue technique for symptomatic (NYHA class II-IV) mitral stenosis (valve area <1.5 cm2). The patients were divided into two groups according to the echo scores of <or=8 (group 1, n=25) and >8 (group 2, n=32). Clinical and echocardiographic evaluations were performed before and after 24-48 hours of PMBV and during the follow-up period, including restenosis and major cardiovascular events.
  
  
  RESULTS
  Patients in group 2 had significantly higher rates of atrial fibrillation (53.1% vs. 16%; p=0.006) and functional capacity of NYHA class III-IV (90.7% vs. 56%; p=0.01). Procedural success rates were 96% (n=24) and 90.6% (n=29) in group 1 and 2, respectively. Failure occurred in one patient (4%) in group 1, and in three patients (9.4%) in group 2. One patient in group 1 developed severe mitral stenosis resulting in valve replacement. In group 2, two patients developed hemopericardium. After the procedure, there was a two-fold increase from 1.0+/-0.1 cm2 to 2.0+/-0.2 cm2 in the mean valve area, being more prominent in group 1 (group 1: from 1.1+/-0.1 cm2 to 2.1+/-0.1 cm2; group 2: from 0.9+/-0.1 cm2 to 1.8+/-0.1 cm2; p<0.001). In-hospital mortality or embolic events did not occur, nor did restenosis or major cardiovascular events during a mean follow-up of 21+/-13 months.
  
  
  CONCLUSIONS
  Our results show that PMBV can be performed successfully in patients having a low (<or=8) or higher (9-11) echo score, with satisfactory hemodynamic and symptomatic improvements.
authors.affiliation: Izmir Atatürk Eğitim ve Araştirma Hastanesi Kardiyoloji Kliniği, Izmir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ekinci
authors.forename: Hamza
authors.initials: H
authors.lastname: Duygu
authors.forename: Halit
authors.initials: H
authors.lastname: Acet
authors.forename: Faruk
authors.initials: F
authors.lastname: Ertaş
authors.forename: Cayan
authors.initials: C
authors.lastname: Cakir
authors.forename: Rida
authors.initials: R
authors.lastname: Berilgen
authors.forename: Cem
authors.initials: C
authors.lastname: Nazli
authors.forename: Oktay
authors.initials: O
authors.lastname: Ergene
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods / Q000592:standards*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome