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Teaching Collection
Innovations in the Treatment of Valvular Disease —
Life-Saving Balloon Mitral Valvuloplasty in Patient with Cardiogenic Shock A
November 2001
Elective balloon mitral valvuloplasty (BMV), performed over the last 15 years, has been shown to effectively relieve the symptoms of significant mitral stenosis in a selected group of patients.1,2 BMV performed in patients with suitable valve morphology is as effective as surgical commissurotomy.3,4 Moreover, the procedure is safe1,2,8 and does not carry the morbidity of thoracotomy. The value and safety of emergency BMV in critically ill patients, whose surgical risk is considerable, need to be evaluated. We describe a patient with severe mitral restenosis in acute congestive failure, with pulmonary edema and cardiogenic shock refractory to medical treatment after cardiac arrest, who was successfully treated by BMV.
Case Report. A 39-year-old Indian man with a history of rheumatic fever and closed mitral valvulotomy performed in India 10 years ago was first seen in our hospital one month ago complaining of progressive shortness of breath on effort for the last 2–3 months.
Examination revealed irregular pulse and auscultatory heart rate of
Discussion. Elective BMV is safe and effective in relieving valve stenosis and symptoms in patients with significant mitral stenosis and suitable mitral valve anatomy. On the other hand, effectiveness and safety of emergency BMV in the terminal stage of the disease are yet to be validated. We found only one similar case, which was published by Goldman5 who reported on a successful BMV in a patient with cardiogenic shock caused by severe mitral stenosis. Wing-Hing Chow6 suggested BMV in such patients as a bridge to elective mitral valve replacement to lower the operative risk. The patient in this report was quite ill, having been resuscitated after cardiac arrest with pulmonary edema and cardiogenic shock and established organ damage. We believe cardiogenic shock was related to the severity of mitral stenosis and the tachycardia. The triggering factor of the patient’s deterioration was probably omitting his medication. Fortunately, shock did not persist long. The short duration of shock interrupted by BMV was probably instrumental in recovery of organ function, notably the liver. We thus corroborate the previous report that BMV should be used even in cardiogenic shock and that it may be a life-saving procedure.5
1. Palacios IF. Percutaneous mitral balloon valvulotomy for patients with mitral stenosis. Curr Opin Cardiol 1994;9:164–175.
2. Chen CR, Cheng TO, for the Multicenter Study Group. Percutaneous balloon mitral valvuloplasty by the Inoue technique: A multicenter study of 4,832 patients in China. Am Heart J 1995;129:1197–1202.
3. Patell JJ, Sharma D, Mitha AS, et al. Percutaneous balloon vs. surgical closed commissurotomy for mitral stenosis: A prospective randomized trial. Circulation 1991;83:1179–1185.
4. Arora R, Nair M, Kara GS, et al. Immediate and long-term results of balloon and surgical closed mitral valvulotomy: A randomized comparative study. Am Heart J 1993;125:1091–1094.
5. Goldman JH, Slade A, Clague J. Cardiogenic shock secondary to mitral stenosis treated by balloon mitral valvuloplasty. Cathet Cardiovasc Diagn 1998;43:195–197.
6. Wing-Hing Chow, Tsun-Cheung Chow. Percutaneous balloon mitral valvulotomy as a bridge to elective mitral valve replacement. Cathet Cardiovasc Diagn 1998;43:102.
7. Endrys J, Hayat N, Uthaman B. Transseptal catheterization made safe (free of cardiac tamponade) (Abstr). Eur Heart J 1997;18(Suppl):654.
8. Endrys J, Hayat N, Uthaman B, et al. Mitral balloon valvuloplasty. Cor Vasa 1998;40:276–284.
