N Sutaria1, D B Northridge, T R Shaw. 1. Department of Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
Abstract
OBJECTIVE: To evaluate the significance of commissural calcification, identified by transthoracic echocardiography, on the haemodynamic and symptomatic outcome of mitral balloon valvotomy. METHODS: Commissural calcification was graded from 0-4 using parasternal short axis transthoracic views. The morphology of the mitral valve was also assessed using the Massachusetts General Hospital echo score. SETTING: A tertiary cardiac centre in Scotland. PATIENTS: 300 patients were studied, 85 retrospectively and 215 prospectively. Mean (SD) age was 59.8 (12.7) years, range 13 to 87; 30% had been judged unsuitable for surgery. Median echo score was 6.8 (3.0), range 2-16. MAIN OUTCOME MEASURES: Immediate increase in mitral valve area and in New York Heart Association functional class 1-3 months after balloon valvotomy. RESULTS: On univariate and multivariate analysis, commissural calcification grade was a significant predictor of achieving a mitral valve area of > 1.50 cm(2) without severe mitral reflux. Its influence was greatest in patients with an echo score </= 8: those with commissural calcification grade 0/1 had significantly greater improvement in valve area and symptom status than those with grade 2/3; the proportions of patients achieving a final valve area of > 1.50 cm(2) were 67% and 46%, respectively (p < 0.05). In patients with an echo score of > 8, the influence of commissural calcification was smaller and not significant. CONCLUSIONS: Commissural calcification as assessed by transthoracic echocardiography is a useful predictor of outcome in patients with otherwise "good" valves (echo score </= 8). Calcification of one commissure or more predicts a less than 50% probability of achieving a valve area above 1.50 cm(2) and is an indication for valve replacement in those who are suitable for surgery.
OBJECTIVE: To evaluate the significance of commissural calcification, identified by transthoracic echocardiography, on the haemodynamic and symptomatic outcome of mitral balloon valvotomy. METHODS: Commissural calcification was graded from 0-4 using parasternal short axis transthoracic views. The morphology of the mitral valve was also assessed using the Massachusetts General Hospital echo score. SETTING: A tertiary cardiac centre in Scotland. PATIENTS: 300 patients were studied, 85 retrospectively and 215 prospectively. Mean (SD) age was 59.8 (12.7) years, range 13 to 87; 30% had been judged unsuitable for surgery. Median echo score was 6.8 (3.0), range 2-16. MAIN OUTCOME MEASURES: Immediate increase in mitral valve area and in New York Heart Association functional class 1-3 months after balloon valvotomy. RESULTS: On univariate and multivariate analysis, commissural calcification grade was a significant predictor of achieving a mitral valve area of > 1.50 cm(2) without severe mitral reflux. Its influence was greatest in patients with an echo score </= 8: those with commissural calcification grade 0/1 had significantly greater improvement in valve area and symptom status than those with grade 2/3; the proportions of patients achieving a final valve area of > 1.50 cm(2) were 67% and 46%, respectively (p < 0.05). In patients with an echo score of > 8, the influence of commissural calcification was smaller and not significant. CONCLUSIONS: Commissural calcification as assessed by transthoracic echocardiography is a useful predictor of outcome in patients with otherwise "good" valves (echo score </= 8). Calcification of one commissure or more predicts a less than 50% probability of achieving a valve area above 1.50 cm(2) and is an indication for valve replacement in those who are suitable for surgery.
Authors: M Ben Farhat; M Ayari; F Maatouk; F Betbout; H Gamra; M Jarra; M Tiss; S Hammami; R Thaalbi; F Addad Journal: Circulation Date: 1998-01-27 Impact factor: 29.690
Authors: H C Herrmann; K Ramaswamy; J M Isner; T E Feldman; J D Carroll; A D Pichard; T M Bashore; G Dorros; G A Massumi; P Sundram Journal: Am Heart J Date: 1992-07 Impact factor: 4.749
Authors: C R Cannan; R A Nishimura; G S Reeder; D R Ilstrup; D R Larson; D R Holmes; A J Tajik Journal: J Am Coll Cardiol Date: 1997-01 Impact factor: 24.094
Authors: V P Reyes; B S Raju; J Wynne; L W Stephenson; R Raju; B S Fromm; P Rajagopal; P Mehta; S Singh; D P Rao Journal: N Engl J Med Date: 1994-10-13 Impact factor: 91.245
Authors: R Hernandez; C Macaya; C Bañuelos; F Alfonso; J Goicolea; A Iñiguez; A Fernandez-Ortiz; J Castillo; P Aragoncillo; M Gil Aguado Journal: Am J Cardiol Date: 1992-11-01 Impact factor: 2.778
Authors: Nathan Stehouwer; Emmy Okello; Vedant Gupta; Alison L Bailey; Richard Josephson; Sri Krishna Madan Mohan; Mohammed N Osman; Chris T Longenecker Journal: Glob Heart Date: 2017-09-01
Authors: Maria Carmo P Nunes; Robert A Levine; Renato Braulio; Marcelo A Pascoal-Xavier; Sammy Elmariah; Nayana F A Gomes; Juliana R Soares; William A M Esteves; Xin Zeng; Jacob P Dal-Bianco; Livia S A Passos; Luiz G Passaglia; Victor T Ribeiro; Cláudio L Gelape; Paulo H N Costa; Lucas Lodi-Junqueira; Walderez Dutra; Timothy C Tan; Elena Aikawa; Judy Hung Journal: JACC Cardiovasc Imaging Date: 2020-09-16