118 Right heart function evolution after successful balloon mitral valvuloplasty

BackgroundThe evolution of right ventricular function in patients with rheumatic mitral stenosis treated with balloon mitral valvuloplasty (BMV) is not clearly defined. The aim of this study was to assess the evolution of systolic, diastolic and global function of the right ventricle (RV) immediately and one month after BMV using a standard Doppler echocardiographic approach combined with tissue Doppler imaging (TDI).MethodsThirty three consecutive patients (70% women; age 31±8 years; range 19–45) with moderate to severe mitral stenosis (mitral valve area≤1.5cm2) in sinus rhythm who underwent successful BMV were included prospectively. Echocardiographic parameters of RV function were determined before BMV, 24 hours after BMV and one month after BMV and included pulsed wave TDI (S velocity, isovolumic relaxation time (IVRT), Tei index), tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), and pulmonary vascular resistance (PVR). The control group included 14 healthy subjects (64% women, age 32±5 years; range 23–45).ResultsMitral valve area increased from 0.88±0.16 to 1.55±0.26cm2 (p<0.0001). Mean mitral valve gradient (MVG) decreased from 16±6 to 6±2mmHg (p<0.0001) immediately after BMV. The RV-right atrium (RA) pressure gradient decreased from 57±25 to 42±13mmHg (p<0.0001) and PVR fell from 2.53±0.92 to 1.86±0.43 Wood units (p<0.0001). There was no significant change with regard to TDI S velocity, RVFAC, IVRT and Tei index. There was a significant increase in TAPSE (p=0.01 immediately after BMV; p=0.0006 at one month) which was correlated with the decrease in PVR, RVRA pressure gradient and MVG. This improvement occurred only in patients with valve area >1.5cm2 after BMV.ConclusionSuccessful BMV results in a significant improvement of RV systolic function assessed by TAPSE in patients with mitral stenosis in sinus rhythm and with mitral valve area >1.5cm2 after BMV.Change in TAPSE immediately and 1 month after BM