Key result
Decreased right ventricular systolic pressure (AUC 0.81) and increased valve separation index (AUC 0.76) were the best echocardiographic indicators of successful balloon mitral valvuloplasty.
Why the study?
Do echocardiographic parameters such as right ventricular systolic pressure and mitral valve separation index predict the success of balloon mitral valvuloplasty in juvenile patients with mitral stenosis?
Cohort (n=52)
No
Do echocardiographic parameters such as right ventricular systolic pressure and mitral valve separation index predict the success of balloon mitral valvuloplasty in juvenile patients with mitral stenosis?
Effect estimate: AUC 0.81
In juvenile patients undergoing balloon mitral valvuloplasty, reduction in right ventricular systolic pressure and improved mitral valve separation index are strong echocardiographic indicators of procedural success.
Supports monitoring right ventricular systolic pressure and valve separation index for immediate success after juvenile balloon mitral valvuloplasty; hypothesis-generating pending prospective validation.
BACKGROUND: Different echocardiographic parameters have been studied and validated for assessing the severity of mitral stenosis; however, scant data are available for these markers in the context of balloon mitral valvuloplasty in juvenile age groups (ages ⩽20 years). OBJECTIVES: The aim of the present study was to find out the utility of echocardiographic parameters such as mitral valve separation index, left atrial volume, right ventricular systolic pressure, tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and right ventricular Tei index in predicting success of balloon mitral valvuloplasty and their relation to mitral valve area in juvenile mitral stenosis. METHODS: We carried out a prospective single-centre study involving 52 juvenile mitral stenosis patients undergoing elective valvuloplasty. Success was defined as an increase in mitral valve area ⩾50% or ⩾1.5 cm2. Echocardiographic measurements were taken before and 24 hours after the procedure and statistical analyses were carried out. RESULTS: The mean age of the study population was 14.3 years (SD ±4.55), ranging from 7 to 20 years. Valvuloplasty was successful in 49 out of 52 patients. The mean valve area improved from 0.89 (SD ±0.16) to 1.73 (SD ±0.22) cm2/m2 (p<0.01), and the mean mitral valve gradient decreased from 19.87 (SD ±7.89) to 7.45 (SD ±2.07) (p=0.021). All the surrogate parameters improved favourably after valvuloplasty (p<0.01). The decrease in right ventricular systolic pressure was a better indicator of the success followed by the increase in valve separation index (area under the curve 0.81 and 0.76, respectively). CONCLUSIONS: All the surrogate markers studied showed favourable improvement, and right ventricular systolic pressure reduction and improved mitral valve separation index were better indicators of successful valvuloplasty.
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Pillai et al. (2015) conducted a cohort in juvenile mitral stenosis (n=52). Echocardiographic parameters (e.g., right ventricular systolic pressure, mitral valve separation index) was evaluated on predicting success of balloon mitral valvuloplasty (increase in mitral valve area ⩽50% or ⩽1.5 cm2) (AUC 0.81). Decreased right ventricular systolic pressure (AUC 0.81) and increased valve separation index (AUC 0.76) were the best echocardiographic indicators of successful balloon mitral valvuloplasty.
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