title: Changes in mitral regurgitation after balloon aortic valvuloplasty.
abstract: The coexistence of mitral regurgitation (MR) in patients with severe aortic stenosis (AS) is not infrequent and has been associated with adverse outcome. The aims of this study were to evaluate the change in MR severity and to identify the correlates of MR improvement in patients with severe AS and moderate to severe MR who underwent balloon aortic valvuloplasty (BAV). Patients with severe AS and at least moderate MR who underwent their first BAV procedures (n = 74) were divided into 2 groups: patients with improved- (n = 34 [46%]) and those without improved (n = 40 [54%]) MR after BAV on transthoracic echocardiography. The population had a mean age of 84 years and was more frequently female (63.5%), with a high risk profile (mean Society of Thoracic Surgeons score 15%, mean European System for Cardiac Operative Risk Evaluation score 57%). Baseline characteristics were balanced between the 2 groups. Patients with improved MR after BAV had smaller left atrial dimensions (45 ± 7 vs 49 ± 7 mm, p = 0.01) and lower peak aortic velocities (3.7 ± 0.6 vs 4.0 ± 0.8 m/s, p = 0.05) and mean transaortic valve gradients (33.2 ± 12.1 vs 40.6 ± 17.4 mm Hg, p = 0.05) at baseline. Left atrial dimension [odds ratio (OR) 3.37, p = 0.006], left ventricular end-diastolic dimension (OR 2.7, p = 0.04), and mean transaortic valve gradient (OR 1.04, p = 0.05), but not left ventricular systolic function or functional MR, were correlated with MR improvement by logistic regression analysis. In conclusion, nearly half of the patients with severe AS and coexistent MR showed improvement in the magnitude of MR after BAV. Larger left atrial and left ventricular end-diastolic dimensions and higher transaortic valve gradients were associated with lack of MR improvement.
authors.affiliation: Washington Hospital Center, Washington, District of Columbia, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Ana
authors.initials: A
authors.lastname: Laynez-Carnicero
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sardi
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.forename: Lavinia
authors.initials: L
authors.lastname: Mitulescu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Steven A
authors.initials: SA
authors.lastname: Goldstein
authors.forename: Zuyue
authors.initials: Z
authors.lastname: Wang
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000628:therapy*; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index