title: Safety and efficacy of percutaneous balloon mitral valvotomy in severe mitral stenosis with moderate mitral regurgitation - A prospective study.
abstract: BACKGROUND
  Percutaneous balloon mitral valvotomy (PBMV) is generally considered as a contraindication in patients with mitral stenosis (MS) associated with moderate to severe mitral regurgitation (MR). We sought to compare the safety and efficacy of PBMV in patients with severe MS and with moderate MR with those with less than moderate or no MR.
  
  
  METHODS
  Symptomatic patients of MS with mitral valve area ≤1.5cm2were screened into two groups: Group I with moderate MR and Group II with less than moderate or no MR. Clinical and echocardiographic assessments were done at 24h, 1 month, and 6 months post-procedure. A treadmill testing was done prior to PBMV and at 6 months. Primary safety outcome was a composite of cardiovascular death and development of severe MR with or without requirement for mitral valve replacement at 30 days of procedure. Efficacy of the procedure was measured as improvement in functional class, treadmill time, and mitral valve area (MVA) at 6 months.
  
  
  RESULTS
  Seventeen patients with moderate MR and 208 patients with less than moderate MR underwent PBMV. Primary outcome showed no significant difference [2 (11.7%) in Group I vs. 8 (3.85%) in Group II, p=0.36]; occurrence of severe MR was higher in Group I [RR=4.87, 95% C.I.=1.42-16.69]. In Group I patients, improvement in treadmill time was seen in 12 (70.59%), functional class in 13 (76.47%), and MVA in all patients.
  
  
  CONCLUSIONS
  In patients having severe MS associated with moderate MR, PBMV may be a safe option and provides sustained symptomatic benefit.
authors.affiliation: Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Vinayakumar
authors.initials: V
authors.lastname: Desabandhu
authors.affiliation: Department of Cardiology, Government Medical College, Kozhikode, Kerala, India. Electronic address: drpgnithin@gmail.com.
authors.forename: Nithin Gopalan
authors.initials: NG
authors.lastname: Peringadan
authors.affiliation: Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Mangalath Narayanan
authors.initials: MN
authors.lastname: Krishnan
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Balloon valvotomy; Mitral regurgitation; Mitral stenosis