Author + information
- Received April 10, 2020
- Revision received July 13, 2020
- Accepted July 23, 2020
- Published online September 16, 2020.
- Maria Carmo P. Nunes, MD, PhDa,∗ (, )
- Robert A. Levine, MDb,
- Renato Braulio, MD, PhDa,
- Marcelo A. Pascoal-Xavier, MD, PhDc,
- Sammy Elmariah, MD, MPHd,
- Nayana F.A. Gomes, MDa,c,
- Juliana R. Soares, MDa,
- William A.M. Esteves, MD, PhDa,
- Xin Zeng, MD, PhDb,
- Jacob P. Dal-Bianco, MDb,
- Livia S.A. Passos, PHDe,f,
- Luiz G. Passaglia, MD, PhDa,
- Victor T. Ribeiro, MDa,
- Cláudio L. Gelape, MD, PhDa,
- Paulo H.N. Costa, MD, PhDa,
- Lucas Lodi-Junqueira, MD, PhDa,
- Walderez Dutra, PhDe,
- Timothy C. Tan, MD, PhDg,
- Elena Aikawa, MD, PhDf and
- Judy Hung, MDb
- aHospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- bCardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- cLaboratory of Molecular Pathology, Department of Pathological Anatomy and Legal Medicine, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- dDivision of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- eDepartment of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, and National Institutes for Science and Technology, Belo Horizonte, Minas Gerais, Brazil
- fThe Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- gDepartment of Cardiology, Blacktown Hospital, University of Western Sydney, New South Wales, Australia
- ↵∗Address for correspondence:
Dr. Maria Carmo P. Nunes, Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130 100-Belo Horizonte, MG, Brazil.
Objectives The aim of this study was to assess the incidence, mechanisms, and outcomes of mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV).
Background Significant MR continues to be a major complication of PMV, with a wide range in clinical presentation and prognosis.
Methods Consecutive patients with mitral stenosis undergoing PMV were prospectively enrolled. MR severity was evaluated by using quantitative echocardiographic criteria, and its mechanism was characterized by 3-dimensional transesophageal echocardiography, divided broadly into 4 categories based on the features contributing to the valve damage. B-type natriuretic peptide levels were obtained before and 24 h after the procedure. Endpoints estimated cardiovascular death or mitral valve (MV) replacement due to predominant MR.
Results A total of 344 patients, ages 45.1 ± 12.1 years, of whom 293 (85%) were women, were enrolled. Significant MR after PMV was found in 64 patients (18.6%). The most frequent mechanism of MR was commissural, which occurred in 22 (34.4%) patients, followed by commissural with posterior leaflet in 16 (25.0%), leaflets at central scallop or subvalvular damage in 15 (23.4%), and central MR in 11 (17.2%). During the mean follow-up period of 3 years (range 1 day to 10.6 years), 60 patients reached the endpoint. The event-free survival rates were similar among patients with mild or commissural MR, whereas patients with damaged central leaflet scallop or subvalvular apparatus had the worst outcome, with an event-free survival rate at 1 year of only 7%. Long-term outcome was predicted by net atrioventricular compliance (Cn) at baseline and post-procedural variables, including valve area, mean gradient, and magnitude of decrease in B-type natriuretic peptide levels, adjusted for the mechanism of MR.
Conclusions Significant MR following PMV is a frequent event, mainly related to commissural splitting, with favorable clinical outcome. Parameters that express the relief of valve obstruction and the mechanism by which MR develops were predictors of long-term outcomes.
This study was partly funded by grants from CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasília, Brazil), FAPEMIG (Foundation for Research Support of the State of Minas Gerais), and CNPq (National Council for Scientific and Technological Development). Drs. Nunes and Dutra are CNPq scholarship recipients. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received April 10, 2020.
- Revision received July 13, 2020.
- Accepted July 23, 2020.
- 2020 American College of Cardiology Foundation
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