Balloon mitral valvotomy in juvenile rheumatic mitral stenosis: comparison of immediate results with adults

Abstract

Aims: The objective of the study was to study and compare the clinical, echocardiographic and haemodynamic profile of juvenile rheumatic mitral stenosis (age ≤20 years) with severe mitral stenosis in adults, both before and immediately after balloon mitral valvotomy and also to evaluate the safety and efficacy of the procedure in juvenile patients.

Methods: Forty juvenile patients aged 20 years or younger were analysed with 40 consecutive adult patients who underwent balloon mitral valvotomy using Accura balloon in our institution. The procedure was successful in all the patients. The clinical, echocardiographic and haemodynamic parameters were compared pre- and post-balloon mitral valvotomy in both the groups.

Results: New York Heart Association functional class was comparable in both the groups (II and III, 62.5% and 37.5% vs. 60% and 40%). Atrial fibrillation was not seen in the juvenile group whereas 25% of the adult group had atrial fibrillation (p<0.001). Mitral valve deformity was comparable (Wilkins Score - 8.57±0.67 vs. 8.6±0.67, p=NS). Mitral valve area index by 2D echo was 0.62±0.097 cm2/m2 in the juvenile group and 0.621±0.097 cm2/m2 in the adult group (p=0.72) and was larger in the juvenile group (1.38±0.19 vs 1.29±0.18 cm2/m2) after the procedure (p value <0.03). Mitral valve gradient (19.85±7.31 mm hg vs. 14.63±5.33 mm hg. P value<0.001) and mean PASP (70.15±1+.2 mm hg vs. 60.10±19.32 mm of hg. P value <0.02) was higher in the juvenile group before balloon mitral valvotomy, after balloon mitral valvotomy the values were 7.45±2.57 vs. 5.78±2.24 mm of hg, (P<0.003) and 40.48±10.30 vs. 41±15.62 respectively (p=0.85). The mean value for left atrial pressure was comparable in both the groups both pre- and post-balloon mitral valvotomy (P value 0.076 and 0.54 respectively). There was no significant difference in the procedural success (95% vs 100%, p value <0.15).

Conclusion: Balloon mitral valvotomy is safe and effective in young with rheumatic mitral stenosis and provides better immediate results compared to adults.

Keywords: Accura balloon; Atrial fibrillation; Safety; Valvular heart disease; Valvuloplasty.