CT mitral valve calcium score and immediate outcomes after percutaneous transvenous mitral commissurotomy

Accurate morphological assessment is essential for predicting outcomes after percutaneous transvenous mitral commissurotomy (PTMC) in rheumatic mitral stenosis (MS). Computed tomography (CT) allows quantitative assessment of mitral valve calcification which may influence procedural success. This study evaluated the predictive value of mitral valve calcium score (MVCS) beyond the Wilkins score for immediate PTMC outcomes. Patients with severe RMS candidates for PTMC underwent echocardiography and gated CT for Ca scoring. Procedural success was defined as mitral valve area (MVA) ≥ 1.5 cm² or ≥ 50% increase from baseline without development of significant MR, defined as moderate–severe or severe MR. Because CT-derived calcium measures showed a zero-inflated distribution, an exploratory binary analysis of detectable versus non-detectable calcium was performed. Procedural success was achieved in 18/30 patients (60.0%). Failed PTMC was associated with numerically higher Wilkins scores (9.55 ± 1.04 vs. 8.58 ± 1.00; p = 0.05), higher CT-derived mitral valve calcium scores (16.08 ± 30.99 vs. 0.76 ± 3.13; p = 0.929), and a greater burden of moderate–severe or severe post-PTMC MR (41.7% vs. 0.0%). The Wilkins score showed moderate discrimination for immediate outcome (AUC 0.72, 95% CI 0.51–0.93). In patients with rheumatic MS undergoing PTMC, the Wilkins score showed moderate discrimination for immediate procedural outcome, whereas CT-derived mitral valve calcium burden showed numerical but statistically inconclusive associations with procedural failure and post-procedural high-grade MR. CT calcium scoring may serve as a complementary anatomical marker in selected patients, but larger studies are needed to define its incremental value.