Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Faculty of Medicine, Nisantası University, Istanbul, Turkey.
Int J Cardiovasc Imaging. 2022 Mar;38(3):621-629. doi: 10.1007/s10554-021-02452-4. Epub 2021 Oct 24.
Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7-9) and novel 3D TEE score was found 4 (IQR 3-4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS.
二尖瓣交界评价在经皮球囊二尖瓣成形术（PBMV）的成功中是重要的，并且临床实践中使用 Wilkins 评分（WS）。在我们的研究中，我们旨在确定在 redo PBMV 中 WS 是否足以预测手术的成功，并且我们还评估了一种新的评分系统，包括 redo PBMV 前的三维（3D）经食管超声心动图（TEE）评估二尖瓣结构，以评估手术的成功。
这项研究纳入了 50 名接受 redo PBMV 的患者。根据 redo PBMV 手术的成功将患者分为两组，该手术的成功定义为 PBMV 后 MVA≥1.5cm 和超声心动图评估后二尖瓣反流小于中度。通过分析 redo PBMV 前记录的图像并评估二尖瓣交界和钙化情况，创建了一种基于 3D TEE 发现的新评分。研究了传统 WS 和新评分在手术成功中的作用。
在研究组中，36 名患者（72%） redo PBMV 手术成功。整个研究组的 WS 为 8（IQR 7-9），新的 3D TEE 评分为 4（IQR 3-4）。虽然 WS 与手术成功之间没有统计学显著关系（p=0.187），但新的 3D TEE 评分与手术成功之间存在统计学显著关系（p=0.042）。具体而言，当新的 3D TEE 评分<4 时，手术成功率>90%。新的 3D TEE 评分可能是选择适合 redo PBMV 成功的患者的有用评分系统，特别是在因 WS 较高而考虑手术的患者中。
