title: Acute severe mitral regurgitation following balloon mitral valvotomy: echocardiographic features, operative findings, and outcome in 50 surgical cases.
abstract: OBJECTIVE
  To analyze the echocardiographic and operative findings with respect to mitral valve anatomy in individuals undergoing emergency surgery for acute severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV). In addition, the clinical profile and outcomes are highlighted.
  
  
  BACKGROUND
  Acute severe MR is a major complication of BMV. There are only a few reports which have studied the echocardiographic and operative findings in this setting. In addition, optimal timing of surgery is uncertain.
  
  
  METHODS
  Prospective study of 50 consecutive patients undergoing emergency mitral valve replacement (MVR) for acute severe MR following BMV.
  
  
  RESULTS
  In 3855 patients who underwent BMV, acute severe MR developed in 50 cases (1.3%) and was referred for emergency MVR. Hypotension (72%), hypoxia (64%), orthopnea (14%), and pulmonary edema (12%) were the clinical manifestations. Severe MR was secondary to anterior mitral leaflet tear in 36 cases (72%), paracommisural tear with annular involvement in seven cases (14%), posterior mitral leaflet tear in five cases (10%) and chordal tear in two cases (4%). The correlation between two-dimensional transthoracic echocardiography (2D-TTE) and operative finding for mitral valve calcification was found to be strong (r = 0.862), in contrast to submitral fusion, where it was found to be moderate (r = 0.536). In-hospital mortality was 12%. Mortality was higher in patients whose time to surgery was ≥24 hr when compared to those who underwent MVR within 24 hr (P < 0.001).
  
  
  CONCLUSIONS
  Hypotension and hypoxia are the predominant manifestations of acute severe MR following BMV. Anterior mitral leaflet tear is the most common etiology for severe MR. 2D-TTE underestimated the severity of submitral disease. Early MVR (<24 hr) is recommended for optimal outcome.
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India.
authors.forename: Manjunath C
authors.initials: MC
authors.lastname: Nanjappa
authors.forename: Rajiv
authors.initials: R
authors.lastname: Ananthakrishna
authors.forename: Srinivasa K
authors.initials: SK
authors.lastname: Hemanna Setty
authors.forename: Prabhavathi
authors.initials: P
authors.lastname: Bhat
authors.forename: Ravindranath K
authors.initials: RK
authors.lastname: Shankarappa
authors.forename: Arunkumar
authors.initials: A
authors.lastname: Panneerselvam
authors.forename: Giridhar
authors.initials: G
authors.lastname: Kamalapurkar
authors.forename: Seetharama P S
authors.initials: SP
authors.lastname: Bhat
authors.forename: Venugopal Ram
authors.initials: VR
authors.lastname: Rao
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D063126:Balloon Valvuloplasty / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D018618:Echocardiography, Doppler, Color; D004630:Emergencies; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult