Background: Mitral stenosis (MS) after Rheumatic Heart Disease (RHD) has high mortality and morbidity imputing high individual and social cost. Cardiac valvular surgery is the current approach, but mitral balloon valvuloplasty (MBV) was showed as a useful alternative with less risk and less expensive. Nevertheless, there is few and disagreement echocardiographic prognosis criterions for this approach regarding restenosis.
Objective: search echocardiographic differences before and after procedure, focusing restenosis, in adult patients with MS by RHD, which the first episode occurred in adolescence, submitted to MBV.
Patients and Methods: this is a retrospective study of 111 adult patients. Patients were submitted to MBV (10 with and 101 without restenosis). There were analyzed 14 echocardiographic parameters just before the procedure and in follow-up. Statistical analysis: Fisher exact test, Student T test, and ANOVA for repeated measurement. Multivariate analysis was performed by Cox’s regression model. It was employed alpha=0.05.
Results: Ninety-two patients (82.9%) were female, mean age of first episode of RHD was 13.2±3.7 and of valvuloplasty was 36.3±11.9 years. Just before the procedure, calculated mitral area was 8.1±1.6mm2, and left atrium/left ventricle (LA/LV) gradient was 15.0±3.4mmHg. Only LA/LV gradiente was different between groups (non-restenosis vs restenosis): 14.8±3.0 vs 17.1±5.5mmHg – p=0.038. In follow-up of 5 years only LA/LV gradient (p=0.001) was higher and stayed higher in restenosis group. Cox’s regression model confirmed LA/LV gradient as the independent marker for restenosis (p<0.0001).
Conclusion: LA/LV gradient appeared as the main player of dismal MBV outcome of patients with MS induced by RHD.