Mitral Stenosis surgical indications: Difference between revisions

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'''Associate Editor-In-Chief:''' {{CZ}} ; Joanna J. Wykrzykowska, MD Contact at [mailto:jwykrzyk@bidmc.havard.edu];  Phone: 617-767-5343 and Roger J. Laham, MD Contact at [mailto:rlaham@bidmc.harvard.edu]
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====Technique====
* Transvenous transeptal technique is most commonly used with the Inoue balloon system
* [[Fossa ovalis]] lies usually at 1-7 o’clock but this orientation can be distorted in the presence of mitral stenosis where the interatrial septum becomes more flat, horizontal and lower
* For the femoral vein approach a 70 cm Brockenbrough needle should be used or an 8 Fr Mullins sheath and advanced under fluoroscopic guidance with pressure monitoring
* The latter is necessary to monitor for puncture into adjacent structures such as aorta
* Further catheter manipulation may be necessary to direct the catheter into the left ventricle through the mitral valve rather than towards one of the pulmonary veins
* The Mullins sheath is exchanged for a solid-core coiled 0.025 inch guidewire over which a 14 Fr dilator is placed
* This is exchanged for the Inoue balloon (24-30 mm) which inflates in three stages allowing for balloon self-positioning with the last inflation resulting in commissural splitting
====Hemodynamic and Clinical Outcomes====
* Results of the commissurotomy should be assessed with hemodynamics and echocardiography
* If second inflation is needed mitral regurgitation should be assessed
* In general increasing valve area to greater than 1 cm2/m2 is an acceptable result
* Usually the valve area doubles and the pulmonary pressures degrease immediately
* 5 year survival is in the 90% range
== Factors favouring successful percutaneous mitral valvuloplasty ==
Mitral stenosis is amenable to percutaneous mitral valvuloplasty if the echocardiography demonstrates :
* Thickening confined to valve tips
* Good mobility of Anterior mitral valve leaflet
* Little chordal involvement
* not more than trivial [[mitral regurgitation]]
* no left atrial thrombus
* no commissural calcification.
=== Wilkins score ===
A scoring system exists to grade the morphological changes in the mitral valve during assessment with echocardiography. This takes into account 4 characteristics: leaflet mobility, leaflet thickening, valve calcification and involvement of the subvalvular apparatus. The involvement is graded from 0-4. A total score of more than 8 is predictive of a low success post percutaneous mitral valvuloplasty.<ref>Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988;60:299–308. doi: 10.1136/hrt.60.4.299 </ref>
==References==
{{Reflist}}
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
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Latest revision as of 14:54, 8 September 2011