Key result
Immediate procedural success of percutaneous balloon mitral valvotomy was comparable between low gradient and high gradient severe rheumatic mitral stenosis (92.2% vs 96.9%, p=0.231).
Why the study?
The optimal management of low gradient severe rheumatic mitral stenosis with normal cardiac index remains incompletely understood.
Does Percutaneous Balloon Mitral Valvotomy (PBMV) have comparable immediate outcomes in low gradient severe rheumatic mitral stenosis compared to high gradient mitral stenosis?
Cohort (n=149)
Does Percutaneous Balloon Mitral Valvotomy (PBMV) have comparable immediate outcomes in low gradient severe rheumatic mitral stenosis compared to high gradient mitral stenosis?
Percutaneous Balloon Mitral Valvotomy in low gradient severe rheumatic mitral stenosis yields comparable immediate procedural success to high gradient MS, despite different baseline hemodynamic characteristics.
PBMV may be feasible in low-gradient severe MS; leaves open long-term outcomes and optimal selection.
The objective of this study was to assess the clinical, hemodynamic characteristics and immediate outcomes of Percutaneous Balloon Mitral Valvotomy (PBMV) in low gradient severe rheumatic mitral stenosis (LGMS) with normal cardiac index. The optimal management of LGMS remains incompletely understood. We examined 200 consecutive patients with severe rheumatic mitral stenosis (MS) who underwent PBMV between January 2014 and March 2020. Of the 149 patients (who satisfied inclusion criteria), 51 (34.2 %) had LGMS. The mean diastolic pressure gradient (DPG) was 8.70 ± 1.34 mm of Hg in LGMS as compared to 16.2 ± 4.3 mm of Hg in HGMS ( p < 0.001). Patients of LGMS were older (39.5 ± 9.7 vs.34.9 ± 11.0 years, p = 0.012), had lower baseline heart rate (76.8 ± 9.5 vs 81.9 ± 12.5, p = 0.010), higher Mitral valve area (MVA) (1.16 ± 0.19 vs 0.99 ± 0.21 cm 2 , p < 0.001),higher Wilkins score (5.8 ± 1.7 vs 4.9 ± 1.5, p = 0.002) and elevated left ventricular end diastolic pressure (LVEDP) (9.2 ± 2.8 vs 5.8 ± 1.2 mm of Hg, p =<0.001) but lower Pulmonary artery systolic pressure (PASP) (53.1 ± 14.5 vs 62.6 ± 17.8 mm of Hg, p = 0.001) and left atrial (LA) pressure (18.0 ± 3.1vs 22.0 ± 4.4 mm of Hg, p =<0.001). Although, the procedural success rate of PBMV was comparable between LGMS and HGMS (92.2 % vs 96.9 % p = 0.231) but increment in MVA and fall in DPG were significantly higher in HGMS in comparison to LGMS ( p -value<0.05). Significant MS may have "low" gradients during catheterization and yet be symptomatic, and thus low gradients cannot be alone used as a marker of disease severity. LGMS with normal CI is characterized by unique clinical and hemodynamic features. The immediate outcome of PBMV is comparable to HGMS but the hemodynamic parameters to monitor the success of PBMV are significantly different. Low gradient mitral stenosis (LGMS) with normal CI is characterized by low transmitral DPG (≤10 mm of Hg) despite symptomatic severe mitral stenosis. LGMS patients have symptoms similar in severity to HGMS patients but are usually older, have lower heart rate, higher baseline mitral valve area (MVA),higher left ventricular end diastolic pressure (LVEDP) and more subvalvular involvement with relatively lower pulmonary artery systolic pressure and lesser LA hypertension.
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Malviya et al. (2024) conducted a cohort in Severe rheumatic mitral stenosis (n=149). Low gradient severe rheumatic mitral stenosis (LGMS) vs. High gradient severe rheumatic mitral stenosis (HGMS) was evaluated on Procedural success rate of PBMV (p=0.231). Immediate procedural success of percutaneous balloon mitral valvotomy was comparable between low gradient and high gradient severe rheumatic mitral stenosis (92.2% vs 96.9%, p=0.231).
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