Skip to main content
SpringerLink
Log in

Immediate, early and mid-term outcomes following balloon mitral valvotomy in patients having severe rheumatic mitral stenosis with significant tricuspid regurgitation

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

The study examined the influence of significant tricuspid regurgitation (TR) on the immediate, early and mid-term outcomes of patients with severe mitral stenosis (MS) undergoing balloon mitral valvotomy (BMV).

Methods

Among the 818 consecutive patients who underwent elective BMV in this institute from 1997 to 2003, 114 had significant TR. After propensity score–matched analysis, the data of 93 patients with significant TR were compared with the data of 93 patients who had no significant TR at the baseline. Outcomes were assessed immediately, at 1 year (early) and at 5 years (mid-term) after BMV.

Results

Patients with significant TR presented more frequently with NYHA class III–IV status, atrial fibrillation (AF), severe pulmonary hypertension (PH), advanced mitral valve disease as assessed by echocardiographic score > 8, and with history of previous BMV. After propensity score–matched analysis, it was found that the immediate procedural success (54.8% vs. 58.1%, P = 0.650), immediate in-hospital events and prevalence of AF and heart failure at 1 year of follow-up were comparable between the two groups. At 5 years after BMV, the significant TR group had higher prevalence of heart failure and AF, greater attrition in mitral valve area (MVA) and higher pulmonary artery (PA) pressure.

Conclusions

Significant TR identifies a sicker patient population with MS. Even though patients with significant TR have comparable immediate and early outcomes after BMV, they have poor outcomes on mid-term follow-up. Longer follow-up with more patients is needed to assess survival aspect of TR on patients undergoing BMV and also to look at the need for interventions to address the significant TR, apart from the mitral valve interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lee SP, Kim HK, Kim KH, et al. Prevalence of significant tricuspid regurgitation in patients with successful percutaneous mitral valvuloplasty for mitral stenosis: results from 12 years’ follow-up of one centre prospective registry. Heart. 2013;99:91–7.

    Article  Google Scholar 

  2. Boyaci A, Gokce V, Topaloglu S, Korkmaz S, Goksel S. Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis. Angiology. 2007;58:336–42.

    Article  Google Scholar 

  3. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol. 2009;53:401–8.

    Article  Google Scholar 

  4. Sagie A, Schwammenthal E, Newell JB, et al. Significant tricuspid regurgitation is a marker for adverse outcome in patients undergoing percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol. 1994;24:696–702.

    Article  CAS  Google Scholar 

  5. Ruel M, Rubens FD, Masters RG, Pipe AL, Bedard P, Mesana TG. Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves. J Thorac Cardiovasc Surg. 2004;128:278–83.

    Article  Google Scholar 

  6. Mohanan Nair KK, Pillai HS, Thajudeen A, et al. Immediate and long-term results following balloon mitral valvotomy in patients with atrial fibrillation. Clin Cardiol. 2012;35:E35–9.

    Article  Google Scholar 

  7. Pillai HS. Percutaneous mitral valvotomy: Jaypee brothers, New Delhi; 2nd Edition 2018. Pages 60–66.

  8. Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg. 2003;75:1826–8.

    Article  Google Scholar 

  9. Song H, Kang DH, Kim JH, et al. Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation. Circulation. 2007;116:I-246–50.

    Article  Google Scholar 

  10. Arora R, Khalilullah M, Gupta MP, Padmavati S. Mitral restenosis. Incidence and epidemiology. Indian Heart J. 1978;30:265–8.

    CAS  PubMed  Google Scholar 

  11. Nanjappa MC, Dorros G, Hemann SK, et al. The Indian experience of percutaneous transvenous mitral commissurotomy: Comparison of the triple lumen and double lumen variable sized single balloon with regard to procedural outcome and cost savings. J Interv Cardiol. 1998;11:107–12.

  12. Rathakrisnnan SS, Ramasamy R, Kaliappan T, Gopalan R, Palanimuthu R, Anandhan P. Immediate outcome of balloon mitral valvuloplasty with JOMIVA balloon during pregnancy. J Clin Diagn Res. 2017;11:OC18–20.

    PubMed  PubMed Central  Google Scholar 

  13. Nair KK, Pillai HS, Titus T, et al. Persistent pulmonary artery hypertension in patients undergoing balloon mitral valvotomy. Pulm Circ. 2013;3:426–31.

    Article  Google Scholar 

  14. Elmaghawry LM, El-Dosouky II, Kandil NT, Sayyid-Ahmad AMS. Pulmonary vascular resistance and proper timing of percutaneous balloon mitral valvotomy. Int J Card Imaging. 2018;34:523–9.

    Article  Google Scholar 

  15. Chorin E, Rozenbaum Z, Topilsky Y, et al. Tricuspid regurgitation and long-term clinical outcomes. Eur Heart J Cardiovasc Imaging. 2020;21:157–65.

    PubMed  Google Scholar 

  16. Ingraham BS, Pislaru SV, Nkomo VT, et al. Characteristics and treatment strategies for severe tricuspid regurgitation. Heart. 2019;105:1244–50.

    Article  CAS  Google Scholar 

  17. Prihadi EA, Delgado V, Leon MB, Enriquez-Sarano M, Topilsky Y, Bax JJ. Morphologic types of tricuspid regurgitation: characteristics and prognostic implications. JACC Cardiovasc Imaging. 2019;12:491–9.

    Article  Google Scholar 

  18. Asmarats L, Taramasso M, Rodés-Cabau J. Tricuspid valve disease: diagnosis, prognosis and management of a rapidly evolving field. Nat Rev Cardiol. 2019;16:538–54.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the guidance and technical support provided Dr. Oomen P. Mathew in statistical analysis.

Funding

Nil

Author information

Authors and Affiliations

  1. Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India

    Krishna Kumar Mohanan Nair, Ajitkumar Valaparambil, Bijulal Sasidharan, Sanjay Ganapathi, Arun Gopalakrishnan, Narayanan Namboodiri & Harikrishnan Sivadasanpillai

Authors
  1. Krishna Kumar Mohanan Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ajitkumar Valaparambil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bijulal Sasidharan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sanjay Ganapathi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arun Gopalakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Narayanan Namboodiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harikrishnan Sivadasanpillai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harikrishnan Sivadasanpillai.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

We confirm that the retrospective study was approved by the SCTIMST Institute Ethics Committee and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was not taken due to retrospective nature of the study which was approved by SCTIMST Institute Ethics Committee.

Ethical approval

Retrospective study approved by SCTIMST Institute Ethics Committee.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nair, K.K.M., Valaparambil, A., Sasidharan, B. et al. Immediate, early and mid-term outcomes following balloon mitral valvotomy in patients having severe rheumatic mitral stenosis with significant tricuspid regurgitation. Indian J Thorac Cardiovasc Surg 36, 483–491 (2020). https://doi.org/10.1007/s12055-020-01012-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-020-01012-0

Keywords

Search

Navigation