Severe mitral regurgitation after balloon mitral valvuloplasty is primarily caused by radial leaflet tears associated with significant subvalvular deformity that is often underestimated on pre-procedural echocardiography.
Answers are grounded in this paper and cite their sources.
Alerts to possible underestimation of subvalvular deformity before balloon mitral valvuloplasty; leaves open whether refined imaging alters outcomes.
This study assessed the mechanism of acute mitral regurgitation following balloon mitral valvuloplasty for the treatment of symptomatic mitral stenosis. We studied 25 patients who required mitral valve replacement for severe mitral regurgitation following balloon mitral valvuloplasty. All the mitral valves studied had features of severe mitral stenosis. Radial tear of the mitral leaflet was responsible for mitral regurgitation in 18 (72%) cases. Of these, 16 involved the anterior mitral leaflet and in 2 cases the posterior mitral leaflet was torn. Three patients (12%) had chordal rupture, whereas in 4 (16%) patients pseudo-orifices were formed. All the excised mitral valves showed significant subvalvular deformity which was underestimated in prevalvuloplasty echocardiography. No other factor was found to be associated with disruption of the valve. Hence, we conclude that cusp deformity and subvalvular pathology are responsible for faulty transmission of forces and improper engagement of the balloon, resulting in disruption of the valvular apparatus. The incidence of severe mitral regurgitation following balloon mitral valvuloplasty might be decreased by appropriate prevalvuloplasty assessment and patient selection.
No takes yet. Share an insight, caveat, or question.
Choudhary et al. (1997) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: