Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Cardiologist, Tehran, Iran.
School of Medicine, Department of Internal Medicine, Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
BMC Cardiovasc Disord. 2024 Jun 18;24(1):309. doi: 10.1186/s12872-024-03932-w.
Percutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes.
In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9-10, and Group III: score 11-12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC.
A total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19-2.41, P = 0.003; and OR: 3.90, 95%CI 2.61-5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35-6.27, P = 0.007).
Commissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score ≤ 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV.
经皮球囊二尖瓣成形术（PBMV）是治疗有症状的风湿性二尖瓣狭窄的 ACC/AHA I 类推荐，适用于具有合适瓣膜形态、中重度以下二尖瓣反流（MR）且左心房内无血栓的患者。二尖瓣瓣环再狭窄和显著的二尖瓣反流（MR）是 PBMV 的已知不良结局。本研究旨在评估 PBMV 在严重二尖瓣狭窄患者中的结局以及瓣环交界处钙化（CC）对结局的影响。
在这项单中心回顾性队列研究中，根据 Wilkins 评分将 876 例接受 PBMV 的患者分为三组（组 I：评分≤8 分；组 II：评分 9-10 分；组 III：评分 11-12 分）。患者在术前、PBMV 术后早期以及 6 个月和 24 个月随访时进行评估。主要临床结局定义为严重瓣环再狭窄和/或有症状的严重 MR（中度至重度和重度 MR）或需要二尖瓣置换术（MVR）。比较了有和无 CC 患者之间的结局。
根据 Wilkins 评分，共 876 例平均年龄 46.4±12.3 岁（81.0%为女性）的患者被分为三组。333 例（38.0%）为组 I，501 例（57.2%）为组 II，42 例（4.8%）为组 III。175 例（20.0%）患者存在 CC，其中 95 例（54.3%）前外侧交界钙化，64 例（36.6%）后内侧交界钙化，16 例（9.1%）患者前后交界均钙化。有和无 CC 的患者 Wilkins 评分存在显著差异（P<0.001）。CC 与早期和中期随访时严重有症状的 MR 发生的几率较高相关（OR：1.69，95%CI 1.19-2.41，P=0.003；OR：3.90，95%CI 2.61-5.83，P<0.001），但与瓣环再狭窄无关（P=0.128）。与组 I 相比，组 II 和 III 在早期（II：P=0.784；III：P=0.098）和中期随访时（II：P=0.216；III：P=0.227）发生严重有症状的 MR 的几率均无更高。与组 I 相比，组 II 的患者瓣环再狭窄的几率更高（OR：2.96，95%CI：1.35-6.27，P=0.007）。
瓣环交界处钙化（CC）是 PBMV 术后早期和中期随访时严重有症状的 MR（不良结局的重要决定因素）的独立预测因子。与评分≤8 分的组 I 相比，Wilkins 评分较高的患者更容易发生二尖瓣瓣环再狭窄。应综合考虑 Wilkins 评分和 CC 来评估患者是否适合接受 PBMV。
