title: Echocardiographic parameters for assessing successful balloon mitral valvuloplasty in juvenile age groups.
abstract: BACKGROUND
  Different echocardiographic parameters have been studied and validated for assessing the severity of mitral stenosis; however, scant data are available for these markers in the context of balloon mitral valvuloplasty in juvenile age groups (ages ⩽20 years).
  
  
  OBJECTIVE
  The aim of the present study was to find out the utility of echocardiographic parameters such as mitral valve separation index, left atrial volume, right ventricular systolic pressure, tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and right ventricular Tei index in predicting success of balloon mitral valvuloplasty and their relation to mitral valve area in juvenile mitral stenosis.
  
  
  METHODS
  We carried out a prospective single-centre study involving 52 juvenile mitral stenosis patients undergoing elective valvuloplasty. Success was defined as an increase in mitral valve area ⩾50% or ⩾1.5 cm2. Echocardiographic measurements were taken before and 24 hours after the procedure and statistical analyses were carried out.
  
  
  RESULTS
  The mean age of the study population was 14.3 years (SD ±4.55), ranging from 7 to 20 years. Valvuloplasty was successful in 49 out of 52 patients. The mean valve area improved from 0.89 (SD ±0.16) to 1.73 (SD ±0.22) cm2/m2 (p<0.01), and the mean mitral valve gradient decreased from 19.87 (SD ±7.89) to 7.45 (SD ±2.07) (p=0.021). All the surrogate parameters improved favourably after valvuloplasty (p<0.01). The decrease in right ventricular systolic pressure was a better indicator of the success followed by the increase in valve separation index (area under the curve 0.81 and 0.76, respectively).
  
  
  CONCLUSIONS
  All the surrogate markers studied showed favourable improvement, and right ventricular systolic pressure reduction and improved mitral valve separation index were better indicators of successful valvuloplasty.
authors.affiliation: 1Department of Cardiology,Jawaharlal Institute of Postgraduate Medical Education and Research,Pondicherry,India.
authors.forename: Ajith
authors.initials: A
authors.lastname: Ananthakrishna Pillai
authors.affiliation: 1Department of Cardiology,Jawaharlal Institute of Postgraduate Medical Education and Research,Pondicherry,India.
authors.forename: Geofi
authors.initials: G
authors.lastname: George
authors.affiliation: 2Department of Biometrics and Statistics,Jawaharlal Institute of Postgraduate Medical Education and Research,Pondicherry,India.
authors.forename: Harichandrakumar
authors.initials: H
authors.lastname: Kottyen Thazhath
authors.affiliation: 1Department of Cardiology,Jawaharlal Institute of Postgraduate Medical Education and Research,Pondicherry,India.
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Yerram
mesh_terms: D000293:Adolescent; D063126:Balloon Valvuloplasty; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D012372:ROC Curve; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: Mitral valve area; balloon mitral valvuloplasty; mitral valve separation index; right ventricular function