title: Factors predicting emergency surgery in severe mitral regurgitation following mitral balloon valvotomy.
abstract: OBJECTIVE
  Acute mitral regurgitation (MR) may cause adverse hemodynamics following mitral balloon valvotomy (MBV). Some patients become severely hemodynamically unstable and require emergency mitral valve replacement (MVR), while others remain relatively stable with medical management. The study aim was to identify factors that would predict severe acute MR leading to severe hemodynamic compromise requiring emergency MVR.
  
  
  METHODS
  Between January 2001 and July 2009, a total of 46 patients developed acute severe MR following MBV at the authors' institution. Of these patients, 11 developed severe hemodynamic compromise and required emergency MVR within 6 h of the procedure (group I), while 35 were relatively stable, improved with time, and were discharged with advice to undergo an early MVR (group II).
  
  
  RESULTS
  The demographic profile and routine echocardiographic parameters were comparable between the two groups. In group I, the right ventricular systolic pressure (RVSP) before and after MBV was significantly higher, and a significantly higher level of calcium was present in the mitral valve leaflets. Univariate analysis of the RVSP before and after MBV predicted the occurrence of hemodynamic instability leading to emergency MVR. The receiver operating characteristic (ROC) curve for RVSP before and after MBV had a significant area under the curve (0.944, p < 0.005 and 0.940, p < 0.005, respectively). Based on the ROC data, the pre- and post-MBV RVSPs of 76 mmHg and 77 mmHg, respectively, predicted the possibility of emergency MVR, with sensitivities and specificities of 72% and 63%, and 100% and 90%, respectively.
  
  
  CONCLUSIONS
  Patients undergoing MBV with an RVSP >76 mmHg and the presence of non-commissural calcium on the mitral valve leaflet, or those who develop an RVSP of 77 mmHg following the procedure will very likely require emergency MVR.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. spande@sgpgi.ac.in
authors.forename: Shantanu
authors.initials: S
authors.lastname: Pande
authors.forename: Surendra K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kumar
authors.forename: Ram K
authors.initials: RK
authors.lastname: Shukla
authors.forename: Nishant
authors.initials: N
authors.lastname: Tripathy
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Singh
authors.forename: Nakul
authors.initials: N
authors.lastname: Sinha
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002118:Calcium / Q000502:physiology; D002648:Child; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000453:epidemiology* / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D002118:Calcium