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CLINICAL STUDIES

Emergent balloon mitral valvotomy in patients presenting with cardiac arrest, cardiogenic shock or refractory pulmonary edema

^a Departments of Cardiology and Pathology, King Edward Memorial Hospital, Mumbai, India

Manuscript received June 5, 1997; revised manuscript received March 16, 1998, accepted April 9, 1998.

Address for correspondence: Dr. Yash Y. Lokhandwala, Department of Cardiology, King Edward Memorial Hospital, Parel, Mumbai 400012, India
yashlokhandwala{at}hotmail.com

Objectives. The present study was performed to determine the outcome of emergent balloon mitral valvotomy (BMV) in patients with cardiac arrest, pulmonary edema or cardiogenic shock.

Background. In India, many patients with mitral stenosis present in critical condition. They have high mortality despite surgical relief. The role of BMV in such patients is ill-defined.

Methods. Of 558 patients undergoing BMV between January 1993 and December 1994, 40 presented with cardiogenic shock, cardiac arrest or pulmonary edema refractory to medical treatment and underwent emergent BMV (group I). Elective BMV was performed in the remaining 518 patients (group II).

Results. Age ([mean ± SD] 40 ± 13 vs. 31 ± 9 years, p < 0.05), incidence of atrial fibrillation (35% vs. 11%, p < 0.05), pulmonary artery systolic pressure (PAsP) (64 ± 14 vs. 51 ± 12 mm Hg, p < 0.001) and mitral valve (MV) score (7.4 ± 1.2 vs. 6.4 ± 1, p < 0.001) were higher and MV area lower (0.74 ± 0.17 vs. 0.86 ± 0.14 cm², p < 0.001) in group I patients. After emergent BMV in group I, mitral regurgitation occurred in 15%, and the mortality rate was 35%. Stepwise logistic regression analysis identified MV score 8 (p = 0.008), PAsP 65 mm Hg (p = 0.023) and cardiac output 3.151 liters/min (p = 0.001) as significant predictors of a fatal outcome. Follow-up of 1 to 16 months (median 8) was available in 20 of 26 survivors in group I, of whom 15 were asymptomatic. The gain in MV area and the decrease in transmitral gradient and PAsP obtained immediately after BMV persisted during the follow-up period.

Conclusions. Emergent BMV is feasible in critically ill patients. In-hospital survivors have excellent clinical and hemodynamic status at intermediate follow-up.

Abbreviations and Acronyms   BMV = balloon mitral valvotomy   CPR = cardiopulmonary resuscitation   MR = mitral regurgitation   MS = mitral stenosis   MV = mitral valve   PAsP = pulmonary artery systolic pressure   RHD = rheumatic heart disease   TMG = transmitral gradient