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Archives of cardiovascular diseases
Volume 106, n° 4
pages 249-250 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.014
Feasibility of percutaneous mitral commissurotomy in patients with commissural mitral valve calcifications
 

J. Dreyfus, C. Cimadevilla, E. Brochet, D. Himbert, B. Iung, A. Vahanian, D. Messika-Zeitoun
 Hôpital Bichat, Paris, France 

Background .– Mitral valve calcifications, especially located in the commissural area, are often considered as a relative contra-indication to percutaneous mitral commissurotomy (PMC). We sought to evaluate in a large series of patients with mitral stenosis (MS), PMC results according to the degree and location of mitral valve calcifications.

Methods .– Over a 3years period, all consecutive patients who underwent a PMC at our institution were enrolled in the present study. Calcifications were assessed using transthoracic echocardiography and defined as bright areas with echocardiographic shadowing. According to the distribution of calcifications (within the valves leaflets’ or at the commissural level) and the degree of calcification (independently scored for each commissure from 0 to 3, 0=absent, 1=mild, 2=moderate, 3=severe), three groups were defined: group 1=patients without leaflets’ or commissural calcifications, group 2=patients with leaflets’ calcifications but no significant commissural calcifications and group 3=patients with at least one calcified commissure of grade2. Patients with severe bilateral calcifications were considered not candidate for PMC. A good immediate PMC result was defined as a good valve opening (final valve area1.5cm2) with no mitral regurgitation>2/4.

Results .– We enrolled 464 patients, 261 patients in group 1, 139 patients in group 2 and 64 patients in group 3. Compared to patients in group 1, patients in group 2 and 3 were older, presented more often in atrial fibrillation and with more severe MS. PMC success rate decreased from group 1 to 3. However, a complete opening of at least one commissure was achieved similarly in the 3 groups and in group 3 the calcified commissure could be totally split in 40%.

Conclusion .– In this large series of patients with MS we showed that:

– a successful PMC is obtained less frequently in patients with calcified commissures but;

– a successful PMC can still be achieved in a large proportion of patients;

– the calcified commissure can be split in more than one third of patients.

Our results support the use of PMC as a first line treatment of patients with severe MS even in the presence of commissural calcifications if clinical characteristics are favorable.
All patients (464)Group 1 (261)Group 2 (139)Group 3 (64)PBefore PMCAge, years54±1549+1561±1358+14<0.001Women, %360 (78)211 (81)106 (76)43 (67)0.07Atrial fibrillation, %143 (31)61 (23)56 (40)26 (41)<0.001Valve area, cm21.06±0.221.1+0.221.05+0.200.95±0.24<0.001After PMCValve area, cm21.76±0.271.33±0.261.71±0 261.61±0.23<0.001Mitral regurgitation>2, %45 (10)26 (10)14 (10)5(8)0.86Good immediate results, %384 (33)229 (88)108 (78)47 (73)0.004>1 commissure totally split, %566 (61)319 (61)175 (63)72 (56)0.14Data presented are number of patients (percent) or mean±SD.

 All patients (464) Group 1 (261) Group 2 (139) Group 3 (64) P  
Before PMC       
Age, years 54±15 49+15 61±13 58+14 <0.001 
Women, % 360 (78) 211 (81) 106 (76) 43 (67) 0.07 
Atrial fibrillation, % 143 (31) 61 (23) 56 (40) 26 (41) <0.001 
Valve area, cm2 1.06±0.22 1.1+0.22 1.05+0.20 0.95±0.24 <0.001 
 
After PMC       
Valve area, cm2 1.76±0.27 1.33±0.26 1.71±0 26 1.61±0.23 <0.001 
Mitral regurgitation>2, % 45 (10) 26 (10) 14 (10) 5(8) 0.86 
Good immediate results, % 384 (33) 229 (88) 108 (78) 47 (73) 0.004 
>1 commissure totally split, % 566 (61) 319 (61) 175 (63) 72 (56) 0.14 

Data presented are number of patients (percent) or mean±SD.



© 2013  Published by Elsevier Masson SAS.
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