Does Mitral Valve Commissural Calcification Predicts Restenosis at Long-Term Follow-up After Percutaneous Balloon Mitral Valvuloplasty?

Author(s): Samir Rafla, Tarek Bishay

Percutaneous balloon mitral valvuloplasty (PBMV) is an effective form of treatment for patients with mitral valve stenosis (MS). The commissural (com.) appearance is a factor that is not assessed by the mitral valve (MV) scores (as the Wilkins score). The aim of this study was to determine whether the presence of calcium in the MV coms. as demonstrated echocardiographically, could predict restenosis at 3 years follow-up after PBMV. 220 consecutive patients with rheumatic MS who underwent successful PBMV by using the Inoue balloon catheter were studied prospectively. Com. calcification (calc.) was present in 70 patients (32%). Com. splitting occurred immediately after PBMV in all the 220 patients studied. Bilateral com. splitting was present more significantly in patients without com. calc. than in patients with com. calc. (P < 0.001). 140 patients presented at 3 years follow-up. Com. calc. was present in 35 patients (25%) while the other 105 patients (75%) had no com. calc. Bilateral com. splitting was present more significantly in patients without com. calc. than in patients with com. calc. (P < 0.001). Severe MR was present in 20 patients (14.3%). It was present more significantly in patients with com. calc. than in patients without com. calc. (P < 0.001). Restenosis occurred in 30 patients (21.4%). Conclusion, patients with com. calc. have a lower incidence of bilateral com. splitting; have a higher incidence of severe MR at one year and at 3 years follow-up after PBMV. Old age, large LAD, high total echo score of the MV, MV score ? 8, lower MVA before PBMV, low incidence of bilateral com. splitting, low MVA after PBMV and the presence of com. calc. are significant predictors of restenosis at 3 years follow-up. Com. calc. is a strong predictor of restenosis at 3 years follow-up after PBMV.

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