The impact of commissural morphology on clinical outcome in patients undergoing percutaneous balloon mitral valvuloplasty

We aimed to evaluate the prognostic value of commissural morphology on immediate and short term outcome after Percutaneous balloon mitral valvuloplasty (PBMV). The study included 30 patients with symptomatic mitral stenosis (MS) scheduled for PBMV with these exclusion criteria: left atrial thrombi, High echocardiography score, Moderate to severe mitral regurgitation (MR), Atrial fibrillation (AF) or Calcification. After PBMV, they were randomized into 2 groups: Group I: 12 patients with only opened one commissure and group II: 18 patients with bilateral opened commissures. Following PBMV, the mean mitral valve area (MVA) increased from 0.94 ± 0.19 to 1.86 ± 0.27 cm2 in group I & from 0.91 ± 0.18 to 2.29 ± 0.33 cm2 in group II (p = 0.001). The mean transmitral gradient (MG) decreased from 21.83 ± 4.1 to 8.08 ± 2.9 mmHg in group I and from 18.28 ± 5 to 5.2 ± 1.76 mmHg in group II (p = 0.003). The MVA was 1.85 ± 0.23 cm2 in group I and 2.25 ± 0.31 cm2 in group II (p = 0.001) and MG was 8.09 ± 2.90 mmHg in group I and 5.47 ± 1.79 mmHg in group II (p = 0.001). Three month follow-up: there was no patient developed AF, embolization or severe MR. Also, there was no mortality, redo, or surgery. We concluded that degree of commissural opening and MVA are closely related. The complete bilateral commissural opening is associated with better sustained MVA and functional status. Thus, evaluation of the degree of commissural opening can be considered as a complementary measure of the procedural success in PBMV.