Should we wait until severe pulmonary hypertension develops? Efficacy of percutaneous mitral balloon valvuloplasty in patients with severe pulmonary hypertension: A subgroup analysis of our experience

Background: The primary goal of this study is to evaluate the immediate and long-term effects of percutaneous mitral balloon valvuloplasty (PBMV) on patients with rheumatic mitral stenosis (MS) complicated with severe pulmonary hypertension (PH). Methods: The study population consisted of 85 patients with MS complicated with severe PH (systolic pulmonary pressure > 75 mm Hg). PBMV was performed with Inoue balloon technique. Clinical and echocardiographic follow-up was scheduled at 6 months and 1 year and yearly thereafter. Results: Mitral valve area (MVA) was increased (pre-PBMV MVA was 1.03 +/- 0.21 cm(2), post-PBMV MVA 1.89 +/- 0.34 cm(2), p < 0.001) significantly. The mean and the maximum transmitral pressure gradient significantly decreased (pre-PBMV mean transmitral gradient was 18.47 +/- 6.59 mm Hg, post-PBMV 6.84 +/- 3.84 mm Hg, p < 0.001, pre-PBMV maximum transmitral pressure gradient was 27.6 +/- 8.38 mm Hg, post-PBMV 12.68 +/- 4.74 mm Hg, p < 0.001). Systolic pulmonary artery pressure (SPAP) significantly decreased (pre-PBMV 89.9 +/- 23.38 mm Hg, post-PBMV 54.5 +/- 14.6 mm Hg, p < 0.001). Two patients underwent surgery due to rupture of anterior mitral leaflet. There was no peri-procedural mortality. The procedure time was 29.12 +/- 11.37 min. Follow-up duration was 108.2 +/- 31.4 months. One patient died due to heart failure. One patient underwent re-PBMV and 7 patients mitral valve replacement. At the last follow-up, MVA still remained high (1.52 +/- 0.34 cm(2)) and mean transmitral pressure gradient was low (9.2 +/- 5.7 mm Hg). SPAP was 56.5 +/- 20.8 mm Hg which was the same as after PBMV. Conclusions: PBMV in patients with MS with severe PH is an effective therapy with low procedure time. However, it is recommended to perform PBMV before developing severe PH.