Doppler Echocardiographic Hemodynamic Changes Following Percutaneous Balloon Mitral Valvotomy

Background:
Rheumatic mitral stenosis is a major cardiovascular burden in poorer
nations, causing increasing hemodynamic compromise. Percutaneous
balloon mitral valvotomy (PBMV) has emerged as the preferred
treatment for symptomatic mitral stenosis with a healthy valve shape.
Objective:
This study aimed to assess the doppler echocardiographic
hemodynamic changes following PBMV in individuals with rheumatic
mitral stenosis.
Methods:
This prospective observational analysis comprised 24 patients with
severe rheumatic mitral stenosis who received PBMV between January
and July 2021 at the National Institute of Cardiovascular Diseases in
Dhaka, Bangladesh. Patients aged 21-50 years with a Wilkins score ≤10
were enrolled. Transthoracic doppler echocardiography was performed
24 hours before and 24-48 hours after PBMV to measure peak
transmitral pressure gradient, mean transmitral pressure gradient, and
pulmonary artery systolic pressure. A paired Student’s t-test was used for
statistical analysis, with a significance level of p≤0.05.
Results:
The study cohort was largely female (70.8%), with a mean age range of
21-50 years. All patients complained of shortness of breath, and
additional prevalent symptoms included palpitation (87.5%) and
paroxysmal nocturnal dyspnea (83.33%). After PBMV, peak transmitral
pressure gradient decreased from 18.04±5.23 mmHg to 12.42±5.87
mmHg (31.2% reduction, p=0.0001), mean transmitral pressure
gradient decreased from 10.75±3.15 mmHg to 7.04±4.53 mmHg
(34.5% reduction, p=0.0001), and pulmonary artery systolic pressure
decreased from 33.50±17.41 mmHg to 25.63±13.83 mmHg (23.5%
reduction, p=0.003).
Conclusion:
In individuals with rheumatic mitral stenosis, PBMV immediately
improves doppler hemodynamic parameters such as transmitral
pressure gradients and pulmonary artery pressure. These data show
PBMV’s efficacy in improving hemodynamic outcomes and support its
use as the recommended strategy for appropriate patients with mitral
stenosi