Value of two-dimensional echocardiography in selecting patients and balloon sizes for percutaneous balloon mitral valvuloplasty.

The effect of valvular and subvalvular morphologic features and balloon size/mitral anulus size ratio on results of valvuloplasty were prospectively studied in 38 consecutive patients undergoing mitral valvuloplasty. The severity of valvular and subvalvular disease was graded echocardiographically from grade I to IV (mild to severe) for immobility, thickening, calcification of mitral leaflets and subvalvular thickening and fusion, yielding a maximal total score of 16. The diastolic mitral anulus diameter was measured in the apical four chamber view. After valvuloplasty, the mitral valve area increased from 0.9 +/- 0.3 to 2.2 +/- 0.5 cm2 (p less than 0.001) with increasing mitral regurgitation in 12 (32%) of the 38 patients. Multiple stepwise analysis revealed that the ratio of balloon size and annular size and the severity of subvalvular disease are two independent factors that correlated significantly with the mitral valve area after valvuloplasty (multiple r = 0.65, p less than 0.0002). One of 34 patients with mild subvalvular disease of grade III or less had an unsatisfactory increase in mitral valve area to less than or equal to 1.5 cm2, whereas 3 of 4 patients with severe (grade IV) subvalvular disease had a valve area less than or equal to 1.5 cm2 (p less than 0.002) after valvuloplasty. The increase in mitral regurgitation after valvuloplasty correlated significantly with the ratio of balloon to mitral anulus size and the severity of subvalvular disease (multiple r = 0.53, p less than 0.003). (ABSTRACT TRUNCATED AT 250 WORDS)