title: Intermediate outcomes of rheumatic mitral stenosis post-balloon mitral valvotomy.
abstract: BACKGROUND
  Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosis. Data on intermediate outcomes of this procedure are limited. Thus we investigated the intermediate outcome after balloon mitral valvotomy performed at a large tertiary center in India.
  
  
  METHODS
  Case records and follow-up data of 2330 patients who underwent valvotomy from June 1999 to December 2005 were retrieved from the hospital information system and analyzed.
  
  
  RESULTS
  The median age of the patients was 32 ± 11 years, 1363 were female including 36 who were pregnant, and 379 were in atrial fibrillation. Follow-up ranged from 1 to 14 years (mean 4.5 years, median 4.0 years). The procedural success rate was 93%. Atrial fibrillation, higher functional class, and worse valve morphology were independent predictors of a poor procedural outcome. Patients with sinus rhythm had better event-free survival (10.43 years, 95% confidence interval: 10.1-10.7) compared to those with atrial fibrillation (8.17 years, 95% confidence interval: 7.5-8.8). Patients who achieved a valve area >1.75 cm(2) had a better event-free survival (11.7 years, 95% confidence interval: 11.4-12.0) than those with a valve area of 1.5-1.74 cm(2) (9.3 years, 95% confidence interval: 9.0-9.7). On multivariate analysis, higher functional class, worse valve morphology, and new significant mitral regurgitation were predictors of a poor outcome. Achieved mitral valve area >1.75 cm(2) was an independent predictor of a good outcome.
  
  
  CONCLUSIONS
  Patients with sinus rhythm, less gross valve deformity, and a post-balloon mitral valvotomy area >1.75 cm(2) had better intermediate outcomes.
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Jugal
authors.initials: J
authors.lastname: Sharma
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India golf_pgi@yahoo.co.in.
authors.forename: Pravin K
authors.initials: PK
authors.lastname: Goel
authors.affiliation: Department of Biostatistics, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Chandra Mani
authors.initials: CM
authors.lastname: Pandey
authors.affiliation: Department of Biostatistics, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Awasthi
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Satyendra
authors.initials: S
authors.lastname: Tewari
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Roopali
authors.initials: R
authors.lastname: Khanna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D063126:Balloon Valvuloplasty / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac catheterization; Dilatation; Follow-up studies; Mitral valve stenosis; Rheumatic heart disease