Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty

Mi Jeong Kim, Jae Kwan Song, Jong Min Song, Duk Hyun Kang, Young Hak Kim, Cheol Whan Lee, Myeong Ki Hong, Jae Joong Kim, Seong Wook Park, Seung Jung Park

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Abstract

BACKGROUND - Mild commissural mitral regurgitation (MR) is associated with significantly higher restenosis-free survival after percutaneous mitral valvuloplasty (PMV), which suggests that different mechanisms of significant MR after PMV may have different clinical courses. We therefore analyzed long-term prognostic factors of significant MR after PMV. METHODS AND RESULTS - Echocardiographic and clinical follow-up data on 380 patients were analyzed (286 women, mean age 44±11 years) who underwent PMV with the Inoue balloon technique between 1995 and 2000. Significant MR developed in 47 patients (12.4%). The survival rate at 8 years was 96±3% and 98±10% in patients with and without significant MR, respectively (P=0.084). The most frequent mechanism was commissural MR, or MR that originated at the site of successful commissurotomy, which occurred in 27 of 47 patients (57%), whereas noncommissural MR occurred in 20 (43%) patients, 12 (26%) with subvalvular damage resulting in chordae rupture and flail motion and 8 (17%) with leaflet laceration. The 8-year event-free survival rate was significantly lower in patients with significant MR than in those without (47±8% versus 83±3%, P<0.001) and was significantly higher in patients with commissural versus noncommissural MR (63±11% versus 29±11%, P<0.001). Of the 47 patients with significant MR, who were followed up for 74±29 months, 19 patients (40%) underwent mitral valve replacement, and 28 patients (60%) received medical treatment only. Patients with commissural MR had a significantly lower rate of mitral valve replacement than patients with noncommissural MR (15% versus 70%, P<0.001). Multivariate analysis showed that atrial fibrillation (odds ratio, 7.4; 95% CI, 1.1 to 56.4; P=0.038), mean mitral gradient immediately after PMV (odds ratio, 1.5; 95% CI, 1.1 to 2.0; P=0.009), and the mechanism of MR (odds ratio, 16.7; 95% CI, 2.3 to 122.2; P=0.005) were independent factors associated with mitral valve replacement. CONCLUSIONS - Clinical outcome of patients with significant MR after PMV varied according to MR mechanism and the adequacy of hemodynamic improvement, which is easily assessed by echocardiography immediately after PMV.

Original languageEnglish
Pages (from-to)2815-2822
Number of pages8
JournalCirculation
Volume114
Issue number25
DOIs
Publication statusPublished - 2006 Dec 1

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Mitral Valve Insufficiency
Mitral Valve
Odds Ratio
Survival Rate
Lacerations
Atrial Fibrillation
Disease-Free Survival
Echocardiography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kim, M. J., Song, J. K., Song, J. M., Kang, D. H., Kim, Y. H., Lee, C. W., ... Park, S. J. (2006). Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty. Circulation, 114(25), 2815-2822. https://doi.org/10.1161/CIRCULATIONAHA.106.658088
Kim, Mi Jeong ; Song, Jae Kwan ; Song, Jong Min ; Kang, Duk Hyun ; Kim, Young Hak ; Lee, Cheol Whan ; Hong, Myeong Ki ; Kim, Jae Joong ; Park, Seong Wook ; Park, Seung Jung. / Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty. In: Circulation. 2006 ; Vol. 114, No. 25. pp. 2815-2822.
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title = "Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty",
abstract = "BACKGROUND - Mild commissural mitral regurgitation (MR) is associated with significantly higher restenosis-free survival after percutaneous mitral valvuloplasty (PMV), which suggests that different mechanisms of significant MR after PMV may have different clinical courses. We therefore analyzed long-term prognostic factors of significant MR after PMV. METHODS AND RESULTS - Echocardiographic and clinical follow-up data on 380 patients were analyzed (286 women, mean age 44±11 years) who underwent PMV with the Inoue balloon technique between 1995 and 2000. Significant MR developed in 47 patients (12.4{\%}). The survival rate at 8 years was 96±3{\%} and 98±10{\%} in patients with and without significant MR, respectively (P=0.084). The most frequent mechanism was commissural MR, or MR that originated at the site of successful commissurotomy, which occurred in 27 of 47 patients (57{\%}), whereas noncommissural MR occurred in 20 (43{\%}) patients, 12 (26{\%}) with subvalvular damage resulting in chordae rupture and flail motion and 8 (17{\%}) with leaflet laceration. The 8-year event-free survival rate was significantly lower in patients with significant MR than in those without (47±8{\%} versus 83±3{\%}, P<0.001) and was significantly higher in patients with commissural versus noncommissural MR (63±11{\%} versus 29±11{\%}, P<0.001). Of the 47 patients with significant MR, who were followed up for 74±29 months, 19 patients (40{\%}) underwent mitral valve replacement, and 28 patients (60{\%}) received medical treatment only. Patients with commissural MR had a significantly lower rate of mitral valve replacement than patients with noncommissural MR (15{\%} versus 70{\%}, P<0.001). Multivariate analysis showed that atrial fibrillation (odds ratio, 7.4; 95{\%} CI, 1.1 to 56.4; P=0.038), mean mitral gradient immediately after PMV (odds ratio, 1.5; 95{\%} CI, 1.1 to 2.0; P=0.009), and the mechanism of MR (odds ratio, 16.7; 95{\%} CI, 2.3 to 122.2; P=0.005) were independent factors associated with mitral valve replacement. CONCLUSIONS - Clinical outcome of patients with significant MR after PMV varied according to MR mechanism and the adequacy of hemodynamic improvement, which is easily assessed by echocardiography immediately after PMV.",
author = "Kim, {Mi Jeong} and Song, {Jae Kwan} and Song, {Jong Min} and Kang, {Duk Hyun} and Kim, {Young Hak} and Lee, {Cheol Whan} and Hong, {Myeong Ki} and Kim, {Jae Joong} and Park, {Seong Wook} and Park, {Seung Jung}",
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doi = "10.1161/CIRCULATIONAHA.106.658088",
language = "English",
volume = "114",
pages = "2815--2822",
journal = "Circulation",
issn = "0009-7322",
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}

Kim, MJ, Song, JK, Song, JM, Kang, DH, Kim, YH, Lee, CW, Hong, MK, Kim, JJ, Park, SW & Park, SJ 2006, 'Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty', Circulation, vol. 114, no. 25, pp. 2815-2822. https://doi.org/10.1161/CIRCULATIONAHA.106.658088

Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty. / Kim, Mi Jeong; Song, Jae Kwan; Song, Jong Min; Kang, Duk Hyun; Kim, Young Hak; Lee, Cheol Whan; Hong, Myeong Ki; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung.

In: Circulation, Vol. 114, No. 25, 01.12.2006, p. 2815-2822.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty

AU - Kim, Mi Jeong

AU - Song, Jae Kwan

AU - Song, Jong Min

AU - Kang, Duk Hyun

AU - Kim, Young Hak

AU - Lee, Cheol Whan

AU - Hong, Myeong Ki

AU - Kim, Jae Joong

AU - Park, Seong Wook

AU - Park, Seung Jung

PY - 2006/12/1

Y1 - 2006/12/1

N2 - BACKGROUND - Mild commissural mitral regurgitation (MR) is associated with significantly higher restenosis-free survival after percutaneous mitral valvuloplasty (PMV), which suggests that different mechanisms of significant MR after PMV may have different clinical courses. We therefore analyzed long-term prognostic factors of significant MR after PMV. METHODS AND RESULTS - Echocardiographic and clinical follow-up data on 380 patients were analyzed (286 women, mean age 44±11 years) who underwent PMV with the Inoue balloon technique between 1995 and 2000. Significant MR developed in 47 patients (12.4%). The survival rate at 8 years was 96±3% and 98±10% in patients with and without significant MR, respectively (P=0.084). The most frequent mechanism was commissural MR, or MR that originated at the site of successful commissurotomy, which occurred in 27 of 47 patients (57%), whereas noncommissural MR occurred in 20 (43%) patients, 12 (26%) with subvalvular damage resulting in chordae rupture and flail motion and 8 (17%) with leaflet laceration. The 8-year event-free survival rate was significantly lower in patients with significant MR than in those without (47±8% versus 83±3%, P<0.001) and was significantly higher in patients with commissural versus noncommissural MR (63±11% versus 29±11%, P<0.001). Of the 47 patients with significant MR, who were followed up for 74±29 months, 19 patients (40%) underwent mitral valve replacement, and 28 patients (60%) received medical treatment only. Patients with commissural MR had a significantly lower rate of mitral valve replacement than patients with noncommissural MR (15% versus 70%, P<0.001). Multivariate analysis showed that atrial fibrillation (odds ratio, 7.4; 95% CI, 1.1 to 56.4; P=0.038), mean mitral gradient immediately after PMV (odds ratio, 1.5; 95% CI, 1.1 to 2.0; P=0.009), and the mechanism of MR (odds ratio, 16.7; 95% CI, 2.3 to 122.2; P=0.005) were independent factors associated with mitral valve replacement. CONCLUSIONS - Clinical outcome of patients with significant MR after PMV varied according to MR mechanism and the adequacy of hemodynamic improvement, which is easily assessed by echocardiography immediately after PMV.

AB - BACKGROUND - Mild commissural mitral regurgitation (MR) is associated with significantly higher restenosis-free survival after percutaneous mitral valvuloplasty (PMV), which suggests that different mechanisms of significant MR after PMV may have different clinical courses. We therefore analyzed long-term prognostic factors of significant MR after PMV. METHODS AND RESULTS - Echocardiographic and clinical follow-up data on 380 patients were analyzed (286 women, mean age 44±11 years) who underwent PMV with the Inoue balloon technique between 1995 and 2000. Significant MR developed in 47 patients (12.4%). The survival rate at 8 years was 96±3% and 98±10% in patients with and without significant MR, respectively (P=0.084). The most frequent mechanism was commissural MR, or MR that originated at the site of successful commissurotomy, which occurred in 27 of 47 patients (57%), whereas noncommissural MR occurred in 20 (43%) patients, 12 (26%) with subvalvular damage resulting in chordae rupture and flail motion and 8 (17%) with leaflet laceration. The 8-year event-free survival rate was significantly lower in patients with significant MR than in those without (47±8% versus 83±3%, P<0.001) and was significantly higher in patients with commissural versus noncommissural MR (63±11% versus 29±11%, P<0.001). Of the 47 patients with significant MR, who were followed up for 74±29 months, 19 patients (40%) underwent mitral valve replacement, and 28 patients (60%) received medical treatment only. Patients with commissural MR had a significantly lower rate of mitral valve replacement than patients with noncommissural MR (15% versus 70%, P<0.001). Multivariate analysis showed that atrial fibrillation (odds ratio, 7.4; 95% CI, 1.1 to 56.4; P=0.038), mean mitral gradient immediately after PMV (odds ratio, 1.5; 95% CI, 1.1 to 2.0; P=0.009), and the mechanism of MR (odds ratio, 16.7; 95% CI, 2.3 to 122.2; P=0.005) were independent factors associated with mitral valve replacement. CONCLUSIONS - Clinical outcome of patients with significant MR after PMV varied according to MR mechanism and the adequacy of hemodynamic improvement, which is easily assessed by echocardiography immediately after PMV.

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