Effect of Commissural Calcification on Clinical Outcomes of Percutaneous Mitral Valvuloplasty

Abstract

Abstract Background Percutaneous mitral valvuloplasty (PMV) is a safe and widely used treatment in patients with symptomatic rheumatic mitral stenosis. This study aimed to evaluate short-term and mid-term outcomes of PMV in patients with severe mitral stenosis and the effect of commissural calcifications on the outcomes. Methods Medical records of 961 patients after PMV were reviewed. All patients were evaluated using transthoracic echocardiography before and after 24 hours. Patients were divided into three subgroups based on their Wilkins score (group I: score ≤8, group II: score 9-10, and group III: score 11-12). Also, patients were divided into two subgroups based on the presence or absence of commissural calcification. Patients were evaluated before PMV, 24 hours after the procedure and were followed for 6 and 24 months to evaluate the short-term and mid-term outcomes. The echocardiographic measures (mitral valve area, indexed mitral valve index, mitral valve mean gradient, and pulmonary artery systolic pressure) were compared after PMV, and at 6 months and 24 month follow-ups. Main clinical outcomes (moderate and severe mitral regurgitation and restenosis) were compared between patients with and without commissural calcifications. Results:Mean age of the patients was 46.6 ± 12.2, and 81.7 % of patients (n=785) were females. Groups I, II, and III (based on Wilkins score) consisted of 353 (36.7%), 559 (58.1%), and 49 (5%) patients, respectively. Mitral valve area (MVA) and indexed MVA increased significantly in all three groups; in both short-term and mid-term follow-ups (p<0.0001). The rate of mitral valve restenosis was significantly higher in groups II and III compared to group I (P=0.0001), but the rate of significant mitral regurgitation (MR) (defined as >moderate MR) did not differ statistically between the three groups. Commissural calcification was present in 190 patients (19.77%). Restenosis was significantly higher in the presence of commissural calcification (p<0.0001). Also, the occurrence of significant MR was significantly higher in patients with commissural calcification (P=0.03). Conclusion Both Wilkins score and presence of commissural calcification are associated with a higher incidence of mitral valve restenosis. While there is no strong association between higher Wilkins scores and higher rates of significant mitral regurgitation, commissural calcification is associated with a higher rate of severe mitral regurgitation.