The SAPPHIRE worldwide carotid artery stenting with distal embolic protection registry

Introduction: Percutaneous balloon mitral valvuloplasty (PBMV) is a well-established alternative to commissurotomy and is recommended for patients with Mitral stenosis (MS) and echocardiographic (ECHO) score b8 and no calcified mitral valves. However, the question remains whether simultaneous intracardiac echocardiography (ICE) is useful to perform PBMV in suboptimal candidates without provoking excessive mitral regurgitation (MR). Materials and Methods: Fifty-seven consecutive PBMV procedures under ICE guidance were performed under local anesthesia and mild sedation between May 2004 and October 2008 at University of Alabama at Birmingham. Left femoral vein was used for ICE insertion while the right was used for transseptal access. Transthoracic echocardiography was used to assess the mitral valve pre and post PBMV. The corresponding preand postPBMVmitral valve areas (MVA) were calculated. Inhospital adverse clinical events were collected. Results: There were 10 (18%) men. The mean age was 53.9±14 years (range, 26–94 years). Two thirds had ECHO score N8, and 33% had moderate to severe MR before PBMV. After PBMV, MVA increased from 1.1±0.29 cm to 1.8±0.9 cm (Pb.005) by planimetry, from 1.25±0.58 cm to 1.97±0.57 cm (Pb.005) by Gorlin's formula. The mean mitral valve gradient decreased from 14±5 mm Hg to 7±3 mm Hg (Pb.005). None had cardiac tamponade or died during the procedure. Fifty-two patients (91.2%) had successful PBMV without in-hospital adverse events. Three (5.2%) required MVR. Two patients developed flail MV leaflet due to rupture of chordae. The third with Grade 3 MR prior to PBMV had progressively worsening symptoms for 7 days requiring MVR. One patient, with prePBMV valve area of 0.6 cm had improvement in MVA to 1.4 cm but developed MRSA sepsis and acute renal failure, which resolved during her hospital stay. Conclusion: MS patients with poor MVanatomy and moderate to high risk for PBMV have been traditionally relegated to medical therapy. With ICE guidance, PBMV can be extended to these patients with unsuitable MV anatomy with reasonable procedural success and safety. To our knowledge, this is the largest case series reporting the use of ICE to facilitate PBMV in such moderate to high-risk patients