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Echocardiographic predictors of redo percutaneous balloon mitral valvuloplasty (redo-PBMV), are not well studied and indications depend mainly based on Wilkins score. We aimed to evaluate the immediate results of redo-PMBV and trying to introduce a simplified redo-score for prediction of success of redo-PBMV.
Methods and Results
Two cohorts of symptomatic patients with restenosis (218 patients in the derivation group and 100 patients in the validation group), who have undergone a redo PBMV 8.1 ± 2.9 years after a first successful PBMV were enrolled for the study. The mean Wilkins score in the derivation group was 8.5 ± 1.7 versus 8.4 ± 1.8 in the validation group. PBMV was performed utilizing multitrack technique. Independent echocardiographic predictors of outcome were assigned a points value: mitral valve area <1.0 cm2 (2 points), PMVL/AMVL length ratio <1/2 (2 points), doming distance <12 mm (3 points), mitral annular calcification (mild = 1 point, moderate = 2 points & severe = 3 points), commissural status (no fusion: 0, unifusion: 2 & bi-fusion: 3 points) and choardal length <10 mm (2 points). The minimum score was 5 and the maximum was 13. The ROC analysis shows that the redo score was highly significant in prediction of Redo-PBMV immediate results. The cut-off value of redo score for prediction of favorable outcome was <8 with a sensitivity of 96% and specificity of 85% in the derivation cohort while the sensitivity was 95% and specificity was 85% in validation cohort. The Wilkins' score <8 had a sensitivity of 82% and specificity of 71% in the derivation cohort. On the other hand its sensitivity was 85% and specificity was 70% in validation cohort.
The presented scoring system was significantly more predictive than the Wilkins score and was particularly valuable in predicting outcome in patients with a prior PBMV. It might be a satisfactory scoring for proper selection of patients with mitral restenosis for PBMV.