Changes In MitralValve Morphology Post Percutaneous Transvenous Mitralcommissurotomy A comparative study Between Inoue Balloon Technique &The Percutaneous Metalic Valvotomy Device

Abstract

The objectives of this study were to study the newly developed metalic valvotomy device comparing it with Inoue balloon technique studying the acute changes they produce on the morphology of the mitral valve complex post-valvuloplasty; namely the mitral valve area (MVA), commissural splitting, leaflet mobility, degree of splitting of chordae tendineae, left atrial size and left ventricular size and function. The study group included 30 patients (21 females, 9 males) with symptomatic mitral stenosis. This group was divided into 2 subgroups each of 15 patients; group A dilated by the metalic valvutome and group B dilated by Inoue balloon.

The baseline criteria of both groups before valvuloplasty was comparable as regards (age, sex, functional class, symptoms, history of previous commissurotomy, atrial fibrillation, heart rate, parameters of Wilkins' score, commissural calcium and different echocardiographic parameters). However, the mean body surface area was more in group A (p=0.05) and chordal splitting was less in group A (p=0.02).

Following valvuloplasty, there was significant increase in both groups in mitral valve area (MVA) measured by both 2D and Doppler, commissural splitting both in depth and width, chordal splitting, mitral orifice diameter, ratio of mitral orifice to annulus diameter, aortic root• diameter, ejection fraction (EF), left ventricle end diastolic diameter (LVEDd). Leaflet separation increased significantly only in group A. There was significant decrease in both groups in transmitral pressure gradient, left atrial diameter and anterior and posterior leaflet distances of limited mobility. Left ventricluar end systolic diameter (LVEDs) decreased significantly only in group B. There was no significant change in both groups in mitral valve annulus diameter or heart rate post valvuloplasty.

The MVA(2D) achieved by the valvutome was significantly higher (2.29±0.38 VS 1.91±0.44 cm2). As regards the commissural splitting; the commissural splitting depth score achieved was significantly higher in group A (p<O.0001). When we compared the relative incidence of each degree of commissural splitting in each commissure we found that there was significantly higher incidence of partial splitting of the posterior