Serial assessment of mitral regurgitation by pulsed doppler echocardiography in patients undergoing balloon aortic valvuloplasty

AbstractMitral regurgitation was serially assessed by pulsed Doppler echocardiography in 144 patients undergoing balloon aortic valvuloplasty for symptomatic aortic stenosis. Regurgitant scores of 0, 1, 2 and 3 were assigned to pulsed Doppler patterns corresponding to no, mild, moderate and severe mitral regurgitation, respectively. Before balloon aortic valvuloplasty, mitral regurgitant score correlated significantly (p < 0.005) but weakly with aortic valve area (r = -0.24), left ventricular ejection fraction (r = −0.34) and left ventricular systolic pressure (r = 0.23). There was no significant correlation between mitral regurgitation and either mean catheterization or mean Doppler aortic valve gradient. Balloon aortic valvuloplasty produced significant decreases in both catheterization and Doppler mean transvalvular aortic valve gradients (56 ± 19 to 31 ± 12 and 60 ± 19 to 48 ± 16 mm Hg, respectively; both p < 0.0001) and a significant increase (p < 0.0001) in aortic valve area assessed by catheterization (0.6 ± 0.2 to 0.9 ± 0.3 CM2). Left ventricular ejection fraction did not change, but cardiac output increased (p < 0.0001) and pulmonary capillary wedge pressure decreased (p < 0.0001).Pulsed Doppler findings of mitral regurgitation were present in 102 of the 144 patients. Eighty-eight patients had a score compatible with mild or more severe degrees of mitral regurgitation, and 49 had a score indicative of moderate or severe valvular insufficiency. In the entire group of 144 patients, mitral regurgitant score decreased significantly from 1.1 ± 1.0 to 1.0 ± 1.0 (p < 0.001). When the 88 patients with findings compatible with mild or more severe degrees of mitral regurgitation were considered separately, mitral regurgitant score decreased from 1.8 ± 0.7 to 1.5 ± 0.8 (p < 0.0001). Of the 49 patients with Doppler patterns of moderate or severe mitral regurgitation before dilation, regurgitant score decreased in 38, remained unchanged in 8 and increased (by only 0.5 grade) in 3. In these patients, mean pulmonary capillary wedge pressure decreased from 22 to 19 mm Hg (p < 0.001).This study shows that mitral regurgitation is common in adult patients undergoing balloon aortic valvuloplasty, that it is weakly and inversely correlated with left ventricular ejection fraction, aortic valve area and left ventricular systolic pressure and that its severity decreases after balloon aortic valvuloplasty. A decrease in the severity of mitral regurgitation may be an important mechanism for symptomatic improvement after aortic valvuloplasty