Echo cardiographic Parameters of Left Ventricle May Limit the Use of Multi Track Balloon Mitral Valvuloplasty

For over a decade balloon mitral valvuloplasty has been the treatment of choice for severe mitral stenosis and replaced surgical commissurotomy in many selected cases. In spite of this, balloon mitral valvuloplasty has many disadvantages. Such disadvantage might may related to the effect of left ventricular geometry which was proven to be changed in patient with rheumatic mitral stenosis. The Aim of this Study: Was to evaluate the effect of different left ventricular geometrical parameters on early results of balloon mitral valvuloplasty using Multi-Track balloon system in patients with rheumatic mitral stenosis. Subjects and Methods: The study included (50 subjects): Group I: 10 normal subjects as a control group and group II: 40 patients with symptomatic rheumatic mitral stenosis undergoing Balloon Mitral Valvuloplasty using multi track system. Several echocardiographic parameters were measured in order to study the left ventricular geometry. The baseline criteria for all patients in the two groups were comparable with no significant statistical difference between them. Left ventricular geometry in patients with MS showed that the long axis of the left ventricle was shorter than in normal subjects (7.2±0.7cm VS 7.9±0.5cm with p<0.001 Greater short axis/long axis diameter ratio at every level with the most pronounced in the apical (D3 / L 0.49 ±0.09 VS 0.40±0.05 p<0.001. LV spherical index was markedly increased in group II (0.57±0.09 VS 0.40±0.05 p<0.001. Successful dilatation was achieved in 75% of patient. The left ventricular long axis was found to be the only LV geometrical parameter which affected the early results of BMV as the shorter LV long axis was associated with the more incidence of non-optimal results. By ROC analysis, we reached a cut-off point regarding longitudinal axis of the LV=5.09 cm to ensure an optimum result (100% PPV and 76% NPV) using the multi track system. Conclusion: Balloon valvuloplasty using the multi track system is an effective treatment for rheumatic mitral stenosis however the altered LV geometry especially the longitudinal axis may affect the early outcomes.