Effects of balloon mitral valvuloplasty on left atrial function in mitral stenosis as assessed by pressure-area relation.

OBJECTIVES

This study sought to investigate the changes induced on the pressure-area relation of the left atrium in patients with mitral stenosis after percutaneous balloon mitral valvuloplasty.

BACKGROUND

Left atrial (LA) function is influenced by changes in LA afterload. The latter is increased in mitral stenosis as a result of increased resistance to blood flow imposed by the stenotic mitral valve.

METHODS

We studied the effects of acute alterations of LA afterload induced by retrograde nontransseptal balloon mitral valvuloplasty (RNBMV) on LA function in patients with mitral stenosis. LA pressure-area relations were obtained in 15 patients with mitral stenosis (8 with sinus rhythm, 7 with atrial fibrillation) before and after valvuloplasty, as well as in 15 normal subjects. LA pressure was recorded by a catheter-tipped micromanometer introduced retrogradely into the left atrium while LA area was recorded simultaneously using acoustic quantification. The areas of the A and V loops of the pressure-area relation as well as the LA chamber stiffness constant were calculated.

RESULTS

Balloon valvuloplasty resulted in a significant increase in mitral valve area (p < 0.001) and a substantial reduction of the mean transmitral pressure gradient (p < 0.001) and mean LA pressure (p < 0.001). The area of the A loop in patients with sinus rhythm and the area of the V loop in those with atrial fibrillation increased significantly after completion of the procedure (p < 0.001). Furthermore, LA stiffness decreased in both groups.

CONCLUSIONS

After RNBMV, there is a significant increase in LA pump function in patients with sinus rhythm, a significant increase in LA reservoir function in patients with atrial fibrillation and a significant reduction in LA stiffness in all patients. Marked alterations of the configuration of the LA pressure-area relation occur immediately after successful RNBMV in patients with mitral stenosis.