Percutaneous mitral balloon valvuloplasty was performed in 150 patients. There were 124 women and 26 men (mean age 53 ± 1 years). A left to right shunt through the created atrial communication was present in 28 patients (19%) after valvuloplasty. The pulmonary to systemic flow ratio was s2:l in 4 patients and ≥2:1 in 24. Univariate predictors of left to right shunting after valvuloplasty included older age (p < 0.01), lower cardiac output before mitral valvuloplasty (p < 0.01), higher New York Heart Association functional class before valvuloplasty (p < 0.05), presence of mitral valve calcification under fluoroscopy (p < 0.01) and higher echocardiography score (p < 0.05). Multiple stepwise logistic regression analysis identified the presence of mitral valve calcification (p < 0.02) and lower cardiac output (p < 0.02) as the independent predictors of a left to right shunt through the atrial communication after balloon valvuloplasty.
Follow-up (10 ± 1 months) of patients with an atrial septal defect after valvuloplasty showed that 1) 6 patients died (3 in the hospital and 3 at 2, 16 and 18 months, respectively, after valvuloplasty); 2) an atrial septal defect was demonstrated in 3 of 6 patients who underwent mitral valve replacement (6 ± 0.8 months after valvuloplasty); and 3) 13 patients were in functional class 1,2 patients were in class II and 1 patient was in class III at 13 ± 1 months after valvuloplasty. A persistent atrial septal defect was demonstrated by oximetry in only S of 13 patients who underwent elective right heart catheterization at 11 ± 1 months after mitral valvuloplasty. Doppler color flow echocardiography demonstrated a left to right shunt in only one of the remaining three patients who did not undergo catheterization. Thus, 13 (59%) of 22 patients who had a left to right shunt after mitral balloon valvuloplasty were demonstrated to have no evidence of a left to right shunt through the created atrial communication at follow-up study.
