Percutaneous balloon mitral valvuloplasty: Analysis of echocardiographic and other variables related to outcome

To determine whether mitral valve (MV) morphology influences the result of balloon mitral valvuloplasty (BMV) for mitral stenosis, two-dimensional echocardiography was performed before BMV in 53 patients and in 25 normal controls. The two-dimensional echocardiographic features of MV leaflets: thickness, length and motion, diastolic MV excursion, chordal length, MV annular diameter (MVAnD), subvalvular distance ratio (SDR), and effective balloon dilating area (EBDA) and diameter (EBDD) were then correlated to the immediate post-BMV mitral valve area (MVA). For the total patient population, post-BMV MVA increased from 0.76 ± 0.24 to 1.91 ± 0.59 cm² (p < 0.0001) and mean diastolic transmitral gradient decreased from 20.1 ± 6.15 to 5.8 ± 3.29 mm (p < 0.0001). The patients were divided into two groups on the basis of post-BMV MVA. Group I had post-BMV MVA <2.0 cm² and group II had post-BMV MVA ≥2.0 cm². A statistically significant difference was noted in SDR (0.33 ± 0.057 vs 0.45 ± 0.042, p < 0.0001); mid-MV anulus to tip of papillary muscle (PM) distance (20.0 ± 3.8 vs 27.9 ± 4.54 mm, p < 0.0001); chordal length (4.3 ± 3.6 vs 9.8 ± 3.9 mm, p < 0.0001); diastolic MV excursion (15.5 ± 2.6 vs 18.2 ± 4.2 mm, p < 0.01); leaflet mobility (p < 0.05); and EBDA (4.4 ± 0.6 vs 4.9 ± 0.5 cm², p < 0.01). On discriminant function analysis of all the echocardiographic variables, the SDR had the strongest discriminating power, followed by mid-MV anulus to tip of PM distance, EBDD MVAnD, and EBDA/body surface area (BSA), and had an accuracy of 90.6% for correctly differentiating two groups. We conclude that quantitative assessment of SDR, mid-MV anulus to tip of PM distance, EBDD MVAnD by two-dimensional echocardiography, and EBDA BSA are helpful in predicting the immediate outcome of BMV.