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PERCUTANEOUS MITRAL VALVULOPLASTY AS A PALLIATIVE TREATMENT OPTION IN SEVERE NON-RHEUMATIC MITRAL STENOSIS
A623 JACC April 1, 2014 Volume 63, Issue 12
FIT Clinical Decision Making Percutaneous Mitral Valvuloplasty as a Palliative Treatment Option in Severe NonRheumatic Mitral Stenosis Moderated Poster Contributions Hall C Monday, March 31, 2014, 10:00 a.m.-10:15 a.m.
Session Title: FIT Clinical Decision Making: Valvular and Pericardial Disease Abstract Category: Valvular Heart Disease Presentation Number: 1283M-370B Authors: Joseph T. Knapper, Gregory Hartlage, Stephen Clements, Emory University School of Medicine, Atlanta, GA, USA Background: Surgical valve replacement is the treatment of choice for patients with non-rheumatic mitral stenosis (MS). While there have been reports of successful percutaneous balloon mitral valvuloplasty (PBMV) in MS due to mitral annular calcification that impinges on the mitral orifice, PBMV is typically reserved for rheumatic MS with favorable valve morphology. Patients with severe, non-rheumatic MS who are deemed non-operable present a challenging clinical dilemma due to limited conservative treatment options. Case: An 89-year-old woman with severe, non-rheumatic MS due to mitral annular calcification presented with several weeks of worsening dyspnea and acute renal failure. Her previously rate-controlled atrial fibrillation was now complicated by rapid ventricular response. Physical examination showed signs of low output with congestion: cool extremities, faint peripheral pulses, bibasilar crackles, and intermittent confusion. Six months ago, her mean mitral valve gradient was 22 mmHg, with a valve area of 0.93 cm2, but surgical intervention was deferred due to prohibitive risk. Decision-making: Repeat transthoracic echocardiogram on admission showed a mean mitral valve gradient of 18 mmHg, with a valve area of 0.5 cm2. Beta blockers were titrated in an attempt to improve diastolic filling, but this led to intermittent hypotension. AV nodal ablation with VVI pacing at 55 beats per minute was then attempted, but failed to improve either her symptoms or renal function. After extensive discussion with family, the decision was made to pursue PBMV despite her unfavorable valve anatomy. Valvuloplasty resulted in a reduction in mean valve gradient from 22 to 9 mm Hg. Calculated valve area post-procedure was 1.3 cm2. Her systolic blood pressures rose from the 90’s to the 130’s, and her symptoms significantly improved. After several days of physical therapy, she walked out of the hospital under her own power. Conclusion: PBMV may be an option for palliative treatment of non-operable patients with severe, non-rheumatic mitral stenosis due to mitral annular calcification that impinges on the mitral orifice.
FIT Clinical Decision Making Percutaneous Mitral Valvuloplasty as a Palliative Treatment Option in Severe NonRheumatic Mitral Stenosis Moderated Poster Contributions Hall C Monday, March 31, 2014, 10:00 a.m.-10:15 a.m.
Session Title: FIT Clinical Decision Making: Valvular and Pericardial Disease Abstract Category: Valvular Heart Disease Presentation Number: 1283M-370B Authors: Joseph T. Knapper, Gregory Hartlage, Stephen Clements, Emory University School of Medicine, Atlanta, GA, USA Background: Surgical valve replacement is the treatment of choice for patients with non-rheumatic mitral stenosis (MS). While there have been reports of successful percutaneous balloon mitral valvuloplasty (PBMV) in MS due to mitral annular calcification that impinges on the mitral orifice, PBMV is typically reserved for rheumatic MS with favorable valve morphology. Patients with severe, non-rheumatic MS who are deemed non-operable present a challenging clinical dilemma due to limited conservative treatment options. Case: An 89-year-old woman with severe, non-rheumatic MS due to mitral annular calcification presented with several weeks of worsening dyspnea and acute renal failure. Her previously rate-controlled atrial fibrillation was now complicated by rapid ventricular response. Physical examination showed signs of low output with congestion: cool extremities, faint peripheral pulses, bibasilar crackles, and intermittent confusion. Six months ago, her mean mitral valve gradient was 22 mmHg, with a valve area of 0.93 cm2, but surgical intervention was deferred due to prohibitive risk. Decision-making: Repeat transthoracic echocardiogram on admission showed a mean mitral valve gradient of 18 mmHg, with a valve area of 0.5 cm2. Beta blockers were titrated in an attempt to improve diastolic filling, but this led to intermittent hypotension. AV nodal ablation with VVI pacing at 55 beats per minute was then attempted, but failed to improve either her symptoms or renal function. After extensive discussion with family, the decision was made to pursue PBMV despite her unfavorable valve anatomy. Valvuloplasty resulted in a reduction in mean valve gradient from 22 to 9 mm Hg. Calculated valve area post-procedure was 1.3 cm2. Her systolic blood pressures rose from the 90’s to the 130’s, and her symptoms significantly improved. After several days of physical therapy, she walked out of the hospital under her own power. Conclusion: PBMV may be an option for palliative treatment of non-operable patients with severe, non-rheumatic mitral stenosis due to mitral annular calcification that impinges on the mitral orifice.