title: Effect of balloon mitral valvotomy on left ventricular function in rheumatic mitral stenosis.
abstract: OBJECTIVE
  Mitral stenosis (MS) is found to produce left ventricular (LV) dysfunction in some studies. We sought to study the left ventricular function in patients with rheumatic MS undergoing balloon mitral valvotomy (BMV). Ours is the first study to analyze effect of BMV on mitral annular plane systolic excursion (MAPSE), and to quantify prevalence of longitudinal left ventricular dysfunction in rheumatic MS.
  
  
  METHODS
  In this prospective cohort study, we included 43 patients with severe rheumatic mitral stenosis undergoing BMV. They were compared to twenty controls whose distribution of age and gender were similar to that of patients. The parameters compared were LV ejection fraction (EF) by modified Simpson's method, mitral annular systolic velocity (MASV), MAPSE, mitral annular early diastolic velocity (E'), and myocardial performance index (MPI). These parameters were reassessed immediately following BMV and after 3 months of procedure.
  
  
  RESULTS
  MASV, MAPSE, E', and EF were significantly lower and MPI was higher in mitral stenosis group compared to controls. Impaired longitudinal LV function was present in 77% of study group. MAPSE and EF did not show significant change after BMV while MPI, MASV, and E' improved significantly. MASV and E' showed improvement immediately after BMV, while MPI decreased only at 3 months follow-up.
  
  
  CONCLUSIONS
  There were significantly lower mitral annular motion parameters including MAPSE in patients with rheumatic mitral stenosis. Those with atrial fibrillation had higher MPI. Immediately after BMV, there was improvement in LV long axis function with a gradual improvement in global LV function. There was no significant change of MAPSE after BMV.
authors: Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India. Electronic address: drrajeshgnair@gmail.com.
authors: Gopalan Nair
authors: GN
authors: Rajesh
authors: Senior Resident, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: Pradeep
authors: P
authors: Sreekumar
authors: Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: Vellani
authors: V
authors: Haridasan
authors: Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: C G
authors: CG
authors: Sajeev
authors: Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: Cicy
authors: C
authors: Bastian
authors: Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: D
authors: D
authors: Vinayakumar
authors: Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: P
authors: P
authors: Kadermuneer
authors: Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: Dolly
authors: D
authors: Mathew
authors: Assistant Professor, Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Biju
authors: B
authors: George
authors: Professor and Head, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors: M N
authors: MN
authors: Krishnan
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Balloon mitral valvotomy; Longitudinal left ventricular dysfunction; Mitral annular plane systolic excursion; Mitral annular systolic velocity; Rheumatic mitral stenosis