Since its introduction by Inoue in 1984, percutaneous balloon mitral valvotomy (BMV) has been widely used as an alternative to surgery for the treatment of rheumatic mitral stenosis. The success of BMV relies on heavily on the presence of value morphology suitable for balloon dilation and cardiac ultrasound has become the cornerstone for assessment of patients undergoing this procedure. In young patients with pliant valves and predominant commissural fusion, the success of BMV has been well documented and for such patients this is the treatment of choice. However, with the disappearance of rheumatic fever in developed countries, patients presenting with mitral stenosis to centres such as ours are typically elderly. They often have anatomy less suitable for balloon dilation but surgical risk is also much higher. Experience of BMV in this population is limited, results are less predictable and the selection of patients less straightforward. In a centre with the largest experience of BMV in the UK, I have reported on a series of 405 consecutive patients, mean age 60.7 years, 27.7% over 70 years old. Longer term outcome was recorded in 300 patients over 10 years. I studied the anatomical and clinical characteristics of this diverse group of patients. I evaluated the role of BMV as a definitive treatment where echocardiography showed valve anatomy to be suitable for balloon dilation and as a palliative option in older patients with severe degenerative valve disease but high surgical risk. I identified factors predicting immediate haemodynamic and longer term functional success. I studied in detail the strengths and limitations of two-dimensional transthoracic, transoesophageal and three-dimensional echocardiography for the assessment of patients undergoing BMV. Importantly, I have been able to show that specific evaluation of mitral commissural morphology, a feature not included in current knowledge scoring systems, was a powerful predictor of outcome and could improve the selection of patients referred for BMV in this older population.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:662613 |
| Date | January 2004 |
| Creators | Sutaria, Nilesh |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/23216 |
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