title: Should we wait until severe pulmonary hypertension develops? Efficacy of percutaneous mitral balloon valvuloplasty in patients with severe pulmonary hypertension: A subgroup analysis of our experience.
abstract: BACKGROUND
  The primary goal of this study is to evaluate the immediate and long-term ef-fects of percutaneous mitral balloon valvuloplasty (PBMV) on patients with rheumatic mitral stenosis (MS) complicated with severe pulmonary hypertension (PH).
  
  
  METHODS
  The study population consisted of 85 patients with MS complicated with severe PH (systolic pulmonary pressure > 75 mm Hg). PBMV was performed with Inoue balloon technique. Clinical and echocardiographic follow-up was scheduled at 6 months and 1 year and yearly thereafter.
  
  
  RESULTS
  Mitral valve area (MVA) was increased (pre-PBMV MVA was 1.03 ± 0.21 cm2, post-PBMV MVA 1.89 ± 0.34 cm2, p < 0.001) significantly. The mean and the maximum transmitral pressure gradient significantly decreased (pre-PBMV mean transmitral gradient was 18.47 ± 6.59 mm Hg, post-PBMV 6.84 ± 3.84 mm Hg, p < 0.001, pre-PBMV maximum transmitral pressure gradient was 27.6 ± 8.38 mm Hg, post-PBMV 12.68 ± 4.74 mm Hg, p < 0.001). Systolic pulmonary artery pressure (SPAP) significantly decreased (pre-PBMV 89.9 ± 23.38 mm Hg, post-PBMV 54.5 ± 14.6 mm Hg, p < 0.001). Two patients underwent surgery due to rupture of anterior mitral leaflet. There was no peri-procedural mortality. The procedure time was 29.12 ± 11.37 min. Follow-up duration was 108.2 ± 31.4 months. One patient died due to heart failure. One patient underwent re-PBMV and 7 patients mitral valve replacement. At the last follow-up, MVA still remained high (1.52 ± 0.34 cm2) and mean transmitral pressure gradient was low (9.2 ± 5.7 mm Hg). SPAP was 56.5 ± 20.8 mm Hg which was the same as after PBMV.
  
  
  CONCLUSIONS
  PBMV in patients with MS with severe PH is an effective therapy with low procedure time. However, it is recommended to perform PBMV before developing severe PH.
authors.affiliation: Department of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey. doctorhakan@hotmail.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozkan
authors.forename: Tahsin
authors.initials: T
authors.lastname: Bozat
authors.forename: Selma Kenar
authors.initials: SK
authors.lastname: Tiryakioglu
authors.forename: Hasan
authors.initials: H
authors.lastname: Ari
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: balloon valvuloplasty; long-term results; mitral stenosis; mitral valve; pulmonary hypertension