An in vitro experimental study was performed to investigate the mounting compliance effect on the occluder closing dynamics and the transient pressure at the closing of the mitral Medtronic Hall (MH) mechanical heart valve (MHV). The closing velocity and the transient pressure were simultaneously measured at heart rates of 70, 90, 120, and 140 beats/minute with cardiac outputs of 5.0, 6.0, 7.5, and 8.5 liters/minute, respectively. The experiment was conducted under simulated physiologic ventricular and aortic pressures in a pulsatile mock flow loop. The characteristics of the transient pressure were investigated by detailed mapping of the transient pressure field in the atrial chamber using high frequency pressure transducers. Simultaneous measurements of the occluder closing velocity and the transient pressure around the seat stop of the MH showed that the transient pressure generated on the inflow side dropped below the vapor pressure of liquid during the occluder's sudden deceleration at closing. The amplitude of the transient pressure reduction (TR) was proportional to the occluder approaching velocity. The development of the transient pressure in the rigid and flexible mountings were significantly different. In the rigid mounting (RM), the pressure was reduced below the liquid's vapor pressure and maintained below -350 mmHg for approximately 180 microseconds. Strong signals of high frequency pressure oscillations (HPO) were recorded in the transient pressure traces. The timing of the HPO was found to be consistent with that of the cavitation bubble collapse as observed by others. In the flexible mounting (FM), TR also occurred, but recovered quickly and was followed immediately by a positive pressure spike. Relatively weak HPO appeared in the transient pressure trace. The mapping of the transient pressure field showed that both the transient pressure reduction (on the major orifice side) or rise (on the minor orifice side) as well as the HPO were locally generated near the valve occluder surface. The transient pressure attenuated with distance away from the occluder surface. The HPO were detectable as far as 40 mm away from the occluder surface. The rigid mounting pressure signals showed characteristically two occurrences of high frequency pressure oscillations. The HPO with smaller amplitude occurred first after the initiation of the TR, followed by a burst of strong HPO at about 450 microseconds. It is believed that they were the result of the collapse of cavitation bubbles. The strong HPO did not appear in the flexible mounting signals. The study indicated that the mounting compliance played a significant role in the MHV cavitation inception and the subsequent bubble growth. It also suggested the possibility of detecting the cavitation by using a high frequency pressure transducer positioned in the atrial chamber.

How to cite: Wu, Z. J., Gao, B. Z., & Hwang, N. H. (1995). Transient pressure at closing of a monoleaflet mechanical heart valve prosthesis: mounting compliance effect. The Journal of heart valve disease, 4(5), 553–567.

Increasingly, transcranial Doppler (TCD) systems are being considered as potential tools to determine the thrombogenicity of herat valve prostheses and/or to serve as early warnings of impending thromboembolic strokes. TCD is thought to detect the presence of intracranial arterial microemboli based on high intensity signals (HITS). While the exact cause of these HITS is not known, it has been theorized that they are due in part to mechanical valve induced cavitation. To determine if this is correct, in vitro experiments were conducted to find if TCD could detect mechanical valve induced cavitation bubbles. An in vitro flow system was developed in which 29mm Medtronic Hall, St. Jude Medical and Medtronic Intact valves, one each, were simultaneously subjected to validated non-cavitation and cavitation generating conditions. Polystyrene particles as well as air bubbles were infused into the flow system to provide controls for comparison. The flow field proximal to each valve was interrogated using TCD sample volumes located 2.5 cm proximal to, 1.3 cm proximal to, and at the valvular inflow surface. The TCD system accurately detected both infused air bubbles and polystyrene particles at all sample volume locations. Under known cavitation generating conditions without infused air bubbles, the TCD failed to register HITS at any sample volume location. Even though cavitation at the valve surface might have been masked by a "system generated artifact", cavitation formed bubbles must persist and pass through the two proximal sample volumes if they were to be captured intracranially. These data suggest that the TCD is unable to detect mechanical valve induced cavitation bubbles either because the bubbles are too small, too few, or too short lived. It is therefore probable that clinically recorded HITS associated with mechanical valves are from origins other than valve induced cavitation bubbles.

How to cite: Shu, M. C., Gross, J. M., & Johnson, K. M. (1995). Can cavitation bubbles generated by mechanical heart valves be detected by transcranial Doppler?. The Journal of heart valve disease, 4(5), 542–552.

Five laboratories carried out measurements of cavitation threshold for a common set of six mechanical prosthetic heart valves, two each from three different manufacturers. This study was intended to evaluate to what extent FDA's current guidance for cavitation testing would lead to consistent results in a variety of laboratory settings and to seek areas for improvement in the recommended test protocol. The inter-laboratory study protocol specified: (1) characterization of the test fluid by oxygen content and electrical conductivity, (2) location and frequency response of pressure sensors, (3) determination of ventricular and atrial pressures (P) and loading rates (dP/dt) averaged over the time period of valve closure and over the time periods of 1 ms, 5 ms, and 20 ms prior to video visualization. The protocol did not specify: (1) the fluid pumping equipment to be used to generate cavitation, (2) the pump or fluid parameters adjusted to raise or lower the loading rate, (3) the equipment, technique, or sensitivity used to visualize cavitation, and (4) a specific definition of the threshold for cavitation. Results from the five laboratories are reported. Significant differences in results were observed in dP/dt and in the pressure difference across the valves during closure at cavitation threshold. Specific differences in test systems included a wide range of ventricular compliance and single valved versus double valved test systems. Three single valve systems with compliant ventricles produced results in reasonable agreement with one another. Further similarity in test equipment should be specified to assure adequate interlaboratory reliability for cavitation testing. Areas needing better specification include the design of the valve mount, the design of the cavitation generators, and qualitative criteria for detection of threshold cavitation.

How to cite: Carey, R. F., Porter, J. M., Richard, G., Luck, C., Shu, M. C., Guo, G. X., Elizondo, D. R., Kingsbury, C., Anderson, S., & Herman, B. A. (1995). An interlaboratory comparison of the FDA protocol for the evaluation of cavitation potential of mechanical heart valves. The Journal of heart valve disease, 4(5), 532–541.

Velocity encoding MRI is a new non-invasive technique for measuring cardiac blood flow velocities. Flow in the three directions of space can be measured during the entire heart cycle. However, the analysis of large amount of data obtained from this technique requires specialized computational software packages to provide physicians with efficient analysis tools. A data visualization software package named Magnetic Resonance Imaging Analyzer (MARIAN) was developed. This software package uses visualization, animation, analysis, and computational tools adapted to time series of cardiac MRI data files, all accessible through a sophisticated graphics user interface. MARIAN was used as a tool for the analysis of the left heart blood flow patterns in two groups of human subjects: ten volunteers and eight patients. The patients were diagnosed with incapacitating angina pectoris and previous left ventricular myocardial infarction. Vector plot animations of the left atrial flow were realized for all volunteer examinations. The temporal flow velocity profiles were sampled at the tips of the mitral leaflets and in the lumen of the right upper pulmonary vein, when possible. The isovolumic relaxation time (IVRT) was estimated. The following flow parameters were obtained from the velocity profiles: at the mitral valve, the early diastolic E-wave, the late diastolic A-wave, the time of occurrence of the E- and A- waves; at the right upper pulmonary vein, the systolic S-wave, the early diastolic D-wave and the reverse late diastolic R-wave. The results obtained were consistent with previous studies using similar MRI techniques. Compared to the control group, the patient group exhibited higher isovolumic relaxation time, a lower peak E-wave, and a lower D-wave. MARIAN thus provided a fast, efficient and accurate data visualization tool for the analysis of human data.

How to cite: Milet, S. F., Walker, P. G., Houlind, K., Kim, W. Y., Pedersen, E. M., & Yoganathan, A. P. (1995). MARIAN: an analysis tool for the assessment of left ventricular function measured by velocity encoding MRI. The Journal of heart valve disease, 4(5), 520–530.

A new single-leaflet mechanical heart valve prosthesis was developed and evaluated in vitro and in vivo. The basic design of the closing body is S-shaped, with the leading and trailing edges parallel to the flow direction. This closing body has an additional cross camber and a fixed axis of rotation. The bearing pins of the disc are guided within oblong through bores of the housing, resulting in a self-cleaning effect. The valve housing has a nozzle-shaped configuration in order to avoid flow separation at the inlet and to reduce the associated pressure loss. Development and optimization studies were carried out by means of upscale valve models. After manufacturing of the closing body from pyrolytic carbon and of the orifice from titanium final hydrodynamic evaluation was carried out according to ISO 5840. The results were comparable or better than for bileaflet valves, the cavitation threshold was above a left ventricular dP/dt of 5500 mmHg/sec. The excellent in vitro results were confirmed by in vivo animal studies in calves and sheep with implantation times of 12 months and six months, respectively. These studies were carried out at the RWTH Aachen and at the NIH, Washington. Without any anticoagulation treatment the valves showed excellent results, confirming the concept of a valve design based on advanced engineering techniques.

How to cite: Reul, H., Steinseifer, U., Knoch, M., & Rau, G. (1995). Development, manufacturing and validation of a single-leaflet mechanical heart valve prosthesis. The Journal of heart valve disease, 4(5), 513–519.

Patients with aortic valvular regurgitation due to non-infectious aortitis are at high risk of valve detachment. In this report, a patient with giant cell aortitis is described, who underwent successful aortic root replacement with a cryopreserved aortic homograft, following two Bentall's type operations that resulted in graft detachment.

How to cite: Eishi, K., Nakajima, S., Kitoh, Y., Nakano, K., Motomura, N., Ohmori, F., Tsuji, T., Kosakai, Y., Isobe, F., & Sasako, Y. (1995). Aortic root replacement with a cryopreserved aortic homograft in a patient with giant cell aortitis following two Bentall's type operations. The Journal of heart valve disease, 4(5), 509–512.

Thirteen patients with severe aortic stenosis and left ventricular dysfunction (ejection fraction < 0.50, Group A) received echocardiographic evaluation before, and early and late after isolated aortic valve replacement. The results were compared with those of 11 aortic stenosis patients without left ventricular dysfunction (Group B). Using two-dimensional echocardiography, left ventricular diastolic internal diameter (LVIDd), left ventricular systolic internal diameter (LVIDs), left ventricular wall thickness (interventricular septum + posterior wall: LVWT), left ventricular fractional shortening (FS), left ventricular mass index (LVMI) and left ventricular end-systolic wall stress (ESWS) were assessed before (Pre), at one month (Early) and 4-7.6 (mean 5.5 +/- 1.0) years (Late) after operation. In the early postoperative period in Group A, significant decrease was observed in LVIDd (5.4 +/- 0.8 to 4.5 +/- 1.0 cm, p = 0.010), LVWT (3.3 +/- 0.7 to 2.9 +/- 0.7 cm, p = 0.027) and LVMI (336 +/- 149 to 222 +/- 112 g/M2, p = 0.013). From the early to late postoperative period FS showed significant improvement in both groups (0.23 +/- 0.12 to 0.32 +/- 0.12 in Group A, p = 0.025 and 0.27 +/- 0.07 to 0.36 +/- 0.07, p = 0.014). However, changes of other parameters were not significant and LVMI in Group A remained twice as high as the normal value. It is concluded from the above results, that LV contraction in aortic stenosis patients with preoperative left ventricular dysfunction improved during the late postoperative period. Although LVMI in the early postoperative period significantly decreased as compared with the preoperative value, it showed no further improvement and remained at an abnormally high level. Therefore, early surgical treatment of severe aortic stenosis before appearance of LV dysfunction should be recommended for postoperative recovery from LV hypertrophy.

How to cite: Uwabe, K., Kitamura, M., Hachida, M., Endo, M., Hashimoto, A., & Koyanagi, H. (1995). Long-term outcome of left ventricular dysfunction after surgery for severe aortic stenosis. The Journal of heart valve disease, 4(5), 503–508.

We evaluated the distribution of the nerves in valve tissue of humans to clarify the relationship between mitral valve prolapse and autonomic nerve dysfunction. We studied 15 autopsy specimens of normal mitral valve, 10 prolapsed mitral valves, five each of normal tricuspid, aortic, and pulmonary valves, and three prolapsed mitral valves obtained at cardiac surgery. Immunohistochemical studies utilized the avidinbiotin peroxidase complex (ABC) method and several nerve-related antigens: 1) S-100 protein, glial fibrillary acidic protein (GFAP), and neurofilament protein (NFP) as markers of glial and Schwann cells of the nervous system; 2) choline acetyltransferase (ChAT) to identify cholinergic nerve endings; 3) neuropeptide Y (NPY), a neuropeptide that is distributed in accordance with sympathetic nerves; and 4) calcitonin gene-related peptide (CGRP), a neuropeptide that is distributed in accordance with afferent nerves. Distribution of adrenergic nerve fibers was also examined by fluorescence method. Morphology of nerve endings of the normal mitral valve was studied by electron microscopy. In normal valves, distributions of S-100 protein, GFAP, and NFP immunoreactivities were clearly visible along the subendocardial site on the coaptation aspect of the base-to-body portion of each valve, regardless of the kind of valve. In contrast, there was only a scanty distribution of these reactivities on the physiologic coaptation area of the tip. In prolapsed mitral valves, there was no distribution of S-100-positive protein or other nerve-related antigens in areas of the valve with myxomatous degeneration. Distribution of CGRP, ChAT, and NPY immunoreactivities, and adrenergic fluorescence, were the same as those of the nerve-related antigens in both normal and prolapsed mitral valves. Electron microscopic study of the atrial aspect of normal mitral valves revealed numerous small axons with aggregations of small clear vesicles, indicating cholinergic features. The results suggest that the subendocardial site on the atrial aspect at the middle portion of the mitral valve is rich in nerve endings, including the afferent nerves, and that mechanical stimuli from this area caused by abnormal coaptation in mitral valve prolapse may produce an improper circuit in autonomic nerve function between the central and mitral valve nervous systems.

How to cite: Oki, T., Fukuda, N., Kawano, T., Iuchi, A., Tabata, T., Manabe, K., Kageji, Y., Sasaki, M., Yamada, H., & Ito, S. (1995). Histopathologic studies of innervation of normal and prolapsed human mitral valves. The Journal of heart valve disease, 4(5), 496–502.

Mitral valve regurgitation affects heart ventricle volumes, which can be accurately measured by electron beam tomography (EBT). Most studies have focused on the left ventricle, but findings have failed to resolve some crucial clinical issues. We reviewed EBT studies of 35 patients with moderate mitral valve regurgitation but no ischemia, aortic valve regurgitation, or left ventricular failure to investigate the relationship between right ventricle volumes and ejection fraction and extent of mitral regurgitation. EBT in cine mode was performed during exercise and at rest in 839 patients from 1990-1994. Sixty-one of these showed evidence of significant mitral regurgitation, 35 of whom met the criteria for inclusion in this study. Left and right end-diastolic and end-systolic volumes were computed from the scans, and ventricular stroke volumes, ejection fractions, regurgitant stroke volume, and regurgitant fraction were computed from these values. Correlation coefficients between ventricular values and regurgitant fraction were computed. Regurgitant fraction was significantly and negatively associated with the ejection fraction in the right ventricle (r = -0.55, p < 0.001) but not in the left. Ten of the 35 patients studied had right ventricular ejection fractions of less than 45%. In addition, there was evidence for a subgroup of cases with moderate amounts of regurgitation and dilation of the right ventricle. It is concluded that reduced right ventricular ejection fraction is a common finding in patients with mitral regurgitation without left ventricular failure. It is most commonly observed in cases with large regurgitant fraction and/or with a large right ventricular end-diastolic volume/left ventricular end-diastolic volume ratio. Identification of mitral regurgitation patients with reduced right ventricular ejection fraction may have clinical significance, indicating a sub-group of patients with more severe disease prior to the development of left ventricular dysfunction.

How to cite: Shields, J. P., Watson, P., & Mielke, C. H., Jr (1995). The right ventricle in mitral regurgitation: evaluation by electron beam tomography. The Journal of heart valve disease, 4(5), 490–495.

In recent years coronary artery bypass grafting (CABG) has been extended to include patients with very low left ventricular ejection fractions (LVEF), also frequently with co-existing mild to moderate mitral valve regurgitation (MR). The question is, should such a MR be corrected simultaneously with a myocardial revascularization or not? Between January 1989 and November 1994, 56 patients with preoperative LVEF < or = 25% and echocardiographic evidence of co-existing MR (Grade I: 41%, II: 46%, III: 13%) underwent primary CABG. None of them had simultaneous mitral valve surgery. Twenty-nine patients (52%) had a pulmonary artery pressure (PAP) > 40 mmHg. The mean preoperative LVEF was 17.9 +/- 4.6 (10-25), mean PAP 44.2 +/- 16.1 mmHg. An average of 4.5 +/- 1.5 grafts/patient were placed and five patients had simultaneous repair of a post-infarction left ventricular aneurysm. The overall mortality was 3.6% (2/56). Transient post-operative low cardiac output syndrome occurred in 16 patients (29%). Twenty-one patients (38%) had no postoperative complications at all. The 54 hospital survivors were followed up over a mean period of 12 months (3-36 months). There was one death (eight months postoperatively) and two graft occlusions, not requiring reoperation. At the end of the follow up echocardiography showed that 50 patients (93%) had no (31 patients) or only a very mild Grade I MR (19 patients). Four patients had Grade II MR, none of them requiring mitral valve surgery. All patients improved their NYHA functional class, from 3.4 +/- 0.8 to 1.9 +/- 0.7 and LVEF from 17.9 +/- 4.6 to 44.2 +/- 7.4 (p < 0.001). Coronary artery bypass grafting is a possible treatment for patients with very low LVEF, provided the patient has a two- or three-vessel disease with significant coronary artery stenosis (> 70%) and angina. Mortality and morbidity are low. Moderate co-existing MR (Grade I-III) seems to normalize after myocardial revascularization and should not be surgically corrected therefore at the primary operation.

How to cite: Christenson, J. T., Simonet, F., Bloch, A., Maurice, J., Velebit, V., & Schmuziger, M. (1995). Should a mild to moderate ischemic mitral valve regurgitation in patients with poor left ventricular function be repaired or not?. The Journal of heart valve disease, 4(5), 484–489.

The advantages of chordal preservation in mitral valve replacement have been demonstrated, but there is no detailed information available on the effect of chordal preservation in patients undergoing multiple valve operations. We assessed therefore a series of 61 patients who underwent multiple valvular procedures either with (Group A, n = 42) or without (Group B, n = 19) preservation of the subvalvular structures. Echocardiographic examinations were performed preoperatively, seven days and three months postoperatively. In addition clinical and electrocardiographic examinations were performed. Echocardiographic investigations included left atrial, left and right ventricular diameters and left ventricular length. Preoperatively there were no differences between the two groups. Intra- and postoperative management was similar in the two groups. Postoperative clinical and echocardiographic examinations demonstrated that, although beneficial effects were evident in both groups, improvement of left ventricular function and decrease in left ventricular size were more pronounced in patients in whom chordal preservation was possible.

How to cite: Straub, U. J., Huwer, H., Petzold, T., Kalweit, G., Volkmer, I., & Gams, E. (1995). Preservation of the mitral subvalvular apparatus in multiple valve procedures. The Journal of heart valve disease, 4(5), 477–483.

The role of the subvalvular apparatus in preserving left ventricular (LV) systolic function, regional LV mechanics and three-dimensional contraction synergy has now been generally accepted. We have developed techniques for maintaining the mitral annulopapillary muscle continuity during mitral valve replacement (MVR) to preserve the normal geometry of the left ventricle. From January 1990 through February 1995, a total of 375 patients underwent MVR. In 183 patients, the entire subvalvular apparatus was retained or the mitral annulo-papillary muscle continuity was reconstructed with Gore-tex sutures. There were 100 males and the average patient age was 64 (24-84) years. One hundred and forty-seven patients had mechanical bileaflet valves implanted and the remaining 36 received bioprostheses. One hundred and nine patients underwent isolated MVR with an operative mortality of three (2.8%), 52 patients had combined MVR and coronary surgery with four deaths (7.7%), 15 patients had multiple valve procedures with one death (6.7%) and seven patients had MVR combined with miscellaneous procedures with no operative deaths. All patients underwent transesophageal echocardiography evaluation intra-operatively. In addition, transthoracic echocardiograms performed during the follow up period (3 mo.-5 yrs.) have demonstrated preservation of global LV function with no evidence of LV outflow tract obstruction. We conclude that preserving the LV geometry by normal anatomical chordal preservation or replacement during MVR is a safe technique resulting in gratifying intermediate term results.

How to cite: Sintek, C. F., Pfeffer, T. A., Kochamba, G., Fletcher, A., & Khonsari, S. (1995). Preservation of normal left ventricular geometry during mitral valve replacement. The Journal of heart valve disease, 4(5), 471–476.

A retrospective study of 219 consecutive patients who underwent mitral valve repair for mitral regurgitation or mixed mitral valve disease with at least moderate regurgitation was undertaken. The etiology was degenerative in 151 (68.9%) patients, endocarditis in 24 (10.9%), rheumatic in 22 (10.0%), ischemic in 13 (5.9%), congenital in five (2.3%) and cardiomyopathy in two (0.9%). The average age was 64.8 +/- 10.9 years, the average follow up 30.2 +/- 24.1 months. Pre-operatively, 74% were in NYHA functional class III or IV. Left ventricular function was assessed by angiography and echocardiography, and moderate or severe impairment (ejection fraction < or = 40%) was assumed to represent significant left ventricular dysfunction. There were six (2.7%) hospital deaths, four of which were due to left ventricular dysfunction. The seven-year mortality and seven-year combined mortality and morbidity were 14.4% and 37.1% respectively for complications related to left ventricular dysfunction, and 2.5% and 24.2% respectively for unrelated complications. Subgroup analysis showed that five-year mortality and five-year combined mortality and morbidity due to left ventricular dysfunction were significantly worse in patients who had pre-operative left ventricular dysfunction than those who did not: 28.5% vs. 6.1% (p < 0.001) and 52.4% vs. 17.8% (p < 0.001). There was nevertheless a significant incidence of postoperative left ventricular dysfunction in patients with satisfactory preoperative left ventricular function. In this group, five-year mortality and five-year combined mortality and morbidity due to left ventricular dysfunction were higher in patients who were in NYHA class III or IV preoperatively than in those who were not: 11.2% vs. 0% (NS) and 25.9% vs. 0% (p < 0.01) respectively, particularly if they also had early (3-10 days) post-operative left ventricular dysfunction: 20.4% (p < 0.001) and 41.7% (p < 0.001) respectively. Despite preservation of the mitral apparatus, left ventricular dysfunction remains a major cause of mortality and morbidity following mitral valve repair for mitral regurgitation.

How to cite: Lee, E. M., Shapiro, L. M., & Wells, F. C. (1995). Mortality and morbidity after mitral valve repair: the importance of left ventricular dysfunction. The Journal of heart valve disease, 4(5), 460–470.

Mitral valve replacement with preserving all chordae tendineae in patients with mitral regurgitation has been proved to be beneficial for left ventricular performance in the postoperative period. To evaluate the effectiveness of this technique in patients with mitral stenosis a comparison of the hemodynamic and echocardiographic data between patients having operation with this technique (Group P, n = 15, mean age = 37.5 +/- 12 years), and those having operation with the conventional method of mitral valve replacement (Group C, n = 15, mean age = 39 +/- 10.4 years) was made. The study population was limited to patients who had no clinical evidence of coronary artery disease and if over 40 years of age had normal coronary artery anatomy on coronary arteriography; patients with no evidence of aortic stenosis and/or regurgitation; and patients who had pure mitral stenosis or mitral stenosis with slight regurgitation (Grade 2 or less) with a mean gradient across the mitral valve greater than 10 mmHg. Hemodynamic parameters improved in both groups after the operation. However, echocardiographic measurements obtained six months postoperatively revealed a significant decrease in left ventricular ejection fraction in Group C (61.33 +/- 9.29% preoperatively versus 53.2 +/- 10.3% postoperatively; p < 0.05). The difference between left ventricular ejection fraction diminution of the two groups was statistically significant (-0.71 +/- 6.28% in Group P versus -8.07 +/- 13.35% in Group C; p < 0.01). Left ventricular end systolic and end diastolic dimensions decreased in patients with preserved valves and increased in patients operated on with conventional method without reaching a statistical significance. Sizes of prosthetic valves inserted were in the same range and no significant differences were found in preoperative and postoperative comparison of the two groups in respect to effective mitral orifice area and transvalvular gradient. There were no evidence of prosthetic valve dysfunction and paravalvular leakage and no operative or late deaths. It is concluded that if it is suitable, mitral valve replacement with preservation of chordae tendineae is expected to have a beneficial effect on postoperative left ventricular performance in patients with mitral stenosis.

How to cite: Alhan, C., Kayacioglu, I., Tayyareci, G., Demirtas, M., Idiz, M., Erten, S., Toraman, F., Suzer, A., Dagsali, S., & Tarcan, S. (1995). Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis. The Journal of heart valve disease, 4(5), 453–459.

The ultimate role of percutaneous balloon mitral valvotomy will depend on its potential for sustained improvement. Long-term outcome data including survival, reoperation and thromboembolism are available for surgical commissurotomy. However, length of follow up for percutaneous balloon mitral valvotomy is inadequate to acquire similar end-point data. We therefore hypothesized that comparison of changes in mitral valve area following balloon or surgical commissurotomy would serve as a useful surrogate end-point by which the long-term benefit of percutaneous balloon mitral valvotomy could be determined. Mitral valve area was determined by Doppler echocardiography following percutaneous balloon mitral valvotomy (N = 230) and surgical commissurotomy (N = 241, 130 closed and 111 open mitral commissurotomy). Regression lines of mitral valve area versus interval from intervention were constructed for each of the two groups. Nine clinical and echocardiographic variables were also analyzed to determine their predictive value for low mitral valve areas. Both groups showed similar and significant negative correlations for mitral valve area versus time (r = -0.48, r = -0.6, balloon vs. surgical commissurotomy respectively, p = 0.001 for both groups). The slopes of the regression lines for both groups were also similar (y = -0.007 x +1.9, y = -0.005 x +1.8, y = -0.006 x +1.8, p = NS). There were no differences in the prevalence of mitral regurgitation. Independent predictors of mitral restenosis according to multivariate analysis were time interval from surgery (p < 0.03), composite mitral valve morphology score (p < 0.04) and subvalvular disease (p < 0.04). Thus, there is a progressive decrease in mitral valve area following percutaneous mitral balloon valvotomy that, at least for the available duration of follow up, appears to parallel changes in valve area following closed or open mitral commissurotomy. A less pliable valve and more subvalvular disease are independent predictors of smaller valve areas. These data suggest that the long term clinical outcome following percutaneous balloon mitral valvotomy may be expected to be similar to the available data for surgical commissurotomy.

How to cite: Essop, R., Rothlisberger, C., Dullabh, A., & Sareli, P. (1995). Can the long-term outcomes of percutaneous balloon mitral valvotomy and surgical commissurotomy be expected to be similar?. The Journal of heart valve disease, 4(5), 446–452.