Percutaneous Balloon Mitral Valvuloplasty in Children and Adolescents With Juvenile Rheumatic Mitral Stenosis: Single Centre Experience

TL;DR

This study shows that balloon mitral valvuloplasty is a safe and effective treatment for young patients with rheumatic mitral stenosis, even with subvalvar issues.

Contribution

Demonstrates the efficacy of undersized balloons in PBMV for juvenile rheumatic mitral stenosis with subvalvar pathology.

Findings

Transmitral gradient significantly decreased from 19.93±6.21 mmHg to 3.54±1.1 mmHg after PBMV.

Mitral valve area increased significantly from 0.75±0.18 cm² to 1.6±0.2 cm².

No mortality was observed, and all patients experienced immediate symptomatic improvement.

Abstract

Background

Rheumatic mitral stenosis (MS) in India is known to affect at a younger age, worsen rapidly, and have severe valvar and subvalvar pathology. Surgical interventions involve the risk of needing to redo surgery in the future, in addition to the acute risks of surgery itself and cardiopulmonary bypass. Therefore, percutaneous balloon mitral valvuloplasty (PBMV) has become an attractive alternative option, especially in children who rarely have any significant calcifications.

Method

We report our experience of PBMV in this retrospective study of 46 patients, aged 9 to 17 years (23 males, 23 females), with all being in the New York Heart Association (NYHA) class II/III. Seven patients had significant subvalvar pathology. All patients had severe pulmonary arterial hypertension (PAH). We used Accura balloons (Accura Medizintechnik GmbH, Karben, Germany) and estimated balloon size based on the height formula and used balloons 1-3 mm smaller than those derived from the formula.

Results

We used a smaller balloon in all the patients and had to upgrade in only seven cases. There was a significant reduction in the transmitral gradient from 19.93±6.21 mmHg to 3.54±1.1 mmHg (p<0.001) and a significant increase in the area of the mitral valve from 0.75±0.18 cm2 to 1.6±0.2cm2 (p<0.001). There was immediate symptomatic improvement in all patients, and there was no mortality. Moderate mitral regurgitation (MR) developed in six patients, one patient developed severe MR, and only one of them had subvalvar pathology.

Conclusion

Our results indicate that PBMV is an effective procedure in the younger population with juvenile MS. PBMV performed with undersized balloons (1-3 mm smaller than the height-based estimate) demonstrated comparable efficacy and safety, even in patients with subvalvular pathology.

Figures