INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

COMPLICATIONS AND MANAGEMENT IN PERCUTANEOUS MITRAL BALLOON VALVULOPLASTY

Sidar Şiyar Aydın

Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Türkiye

Aydın SŞ. Complications and Management in Percutaneous Mitral Balloon Valvuloplasty. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.105-113.

ABSTRACT

Although the prevalence of rheumatic valve disease has decreased in developed countries, it continues to be a health concern in developing nations. Rheumatic valve disease primarily affects the mitral valve and can lead to mitral stenosis in adulthood. If left untreated, severe mitral stenosis can result in serious complications, including heart failure, pulmonary hypertension, atrial fibrillation, an increased risk of stroke, and even death. Treatment options include surgery or percutaneous mitral balloon valvuloplasty. Percutaneous mitral balloon valvuloplasty acts as an alternative to surgical intervention for rheumatic mitral stenosis with no more than mild mitral regurgitation. While the complication and mortality rates of percutaneous mitral balloon valvuloplasty are comparable to those of surgery, taking precautions such as selecting appropriate patients, performing thorough echocardiographic evaluations, and ensuring that the procedure is conducted by an experienced operator can help minimize complication rates. The procedure is safe and has a high chance of success, but despite the precautions taken, various complications can occur. In this chapter, we aimed to describe the complications associated with percutaneous mitral balloon valvuloplasty and the management of these complications.

Keywords: Balloon valvuloplasty; Complications; Mitral valve stenosis; Rheumatic heart disease

Referanslar

  1. Peters F, Karthikeyan G, Abrams J, Muhwava L, Zuhlke L. Rheumatic heart disease: current status of diagnosis and therapy. Cardiovasc Diagn Ther. Apr 2020;10(2):305-315. [Crossref]  [PubMed]  [PMC]
  2. Fawzy ME. Mitral balloon valvuloplasty. J Saudi Heart Assoc. Jul 2010;22(3):125-32. [Crossref]  [PubMed]  [PMC]
  3. Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. Mar 1984;87(3):394-402. [Crossref]  [PubMed]
  4. Feldman T, Carroll JD. Percutaneous transvenous balloon mitral commissurotomy: When? For whom? An alternative to surgery in symptomatic mitral stenosis. J Crit Illn. Oct 1991;6(10):1009-27. [PubMed]
  5. Gajjala OR, Durgaprasad R, Velam V, Kayala SB, Kasala L. New integrated approach to percutaneous mitral valvuloplasty combining Wilkins score with commissural calcium score and commissural area ratio. Echocardiography. Sep 2017;34(9):1284-1291. [Crossref]  [PubMed]
  6. Ruiz CE, Zhang HP, Macaya C, Aleman EH, Allen JW, Lau FY. Comparison of Inoue single-balloon versus double-balloon technique for percutaneous mitral valvotomy. Am Heart J. Apr 1992;123(4 Pt 1):942-7. [Crossref]  [PubMed]
  7. Ben Farhat M, Ayari M, Maatouk F, Betbout F, Gamra H, Jarra M, et al. Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. Circulation. Jan 27 1998;97(3):245-50. [Crossref]  [PubMed]
  8. Rifaie O, Abdel-Dayem MK, Ramzy A, Ezz-El-Din H, ElZiady G, El-Itriby A, et al. Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study. J Cardiol. Feb 2009;53(1):28-34. [Crossref]  [PubMed]
  9. Palacios IF, Arzamendi D. Percutaneous Mitral Balloon Valvuloplasty for Patients with Rheumatic Mitral Stenosis. Interv Cardiol Clin. Jan 2012;1(1):45-61. [Crossref]  [PubMed]
  10. Rashid H, Haq ZU, Alam S, Nazir M, Nadir M, Fakhar T, et al. Procedural complications associated with percutaneous mitral balloon valvotomy: A systematic review. Expert Rev Cardiovasc Ther. Dec 2022;20(12):929-932. [Crossref]  [PubMed]
  11. Essop MR, Wisenbaugh T, Skoularigis J, Middlemost S, Sareli P. Mitral regurgitation following mitral balloon valvotomy. Differing mechanisms for severe versus mild-to-moderate lesions. Circulation. Oct 1991;84(4):1669-79. [Crossref]  [PubMed]
  12. Iung B, Nicoud-Houel A, Fondard O, Akoudad H, Haghighat T, Brochet E, et al. Temporal trends in percutaneous mitral commissurotomy over a 15-year period. Eur Heart J. Apr 2004;25(8):701-7. [Crossref]  [PubMed]
  13. Padial LR, Abascal VM, Moreno PR, Weyman AE, Levine RA, Palacios IF. Echocardiography can predict the development of severe mitral regurgitation after percutaneous mitral valvuloplasty by the Inoue technique. Am J Cardiol. Apr 15 1999;83(8):1210-3. [Crossref]  [PubMed]
  14. Sutaria N, Northridge DB, Shaw TR. Significance of commissural calcification on outcome of mitral balloon valvotomy. Heart. Oct 2000;84(4):398-402. [Crossref]  [PubMed]  [PMC]
  15. Kim MJ, Song JK, Song JM, Kang DH, Kim YH, Lee CW, et al. Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty. Circulation. Dec 19 2006;114(25):2815-22. [Crossref]  [PubMed]
  16. Elasfar AA, Elsokkary HF. Predictors of developing significant mitral regurgitation following percutaneous mitral commissurotomy with inoue balloon technique. Cardiol Res Pract.2011;2011:703515. [Crossref]  [PubMed]  [PMC]
  17. Krishnamoorthy KM, Radhakrishnan S, Shrivastava S. Natural history and predictors of moderate mitral regurgitation following balloon mitral valvuloplasty using Inoue balloon. Int J Cardiol. Jan 2003;87(1):31-6. [Crossref]  [PubMed]
  18. Nunes MCP, Levine RA, Braulio R, Pascoal-Xavier MA, Elmariah S, Gomes NFA, et al. Mitral Regurgitation After Percutaneous Mitral Valvuloplasty: Insights Into Mechanisms and Impact on Clinical Outcomes. JACC Cardiovasc Imaging. Dec 2020;13(12):2513-2526. [Crossref]  [PubMed]  [PMC]
  19. Cequier A, Bonan R, Serra A, Dyrda I, Crépeau J, Dethy M, Waters D. Left-to-right atrial shunting after percutaneous mitral valvuloplasty. Incidence and long-term hemodynamic follow-up. Circulation. Apr 1990;81(4):1190-7. [Crossref]  [PubMed]
  20. Harikrishnan S, Titus T, Tharakan JM. Septal defects after percutaneous mitral valvotomy--all are not innocent. J Am Soc Echocardiogr. Feb 2005;18(2):183-4. [Crossref]  [PubMed]
  21. Kronzon I, Tunick PA, Goldfarb A, Freedberg RS, Chinitz L, Slater J, et al. Echocardiographic and hemodynamic characteristics of atrial septal defects created by percutaneous valvuloplasty. J Am Soc Echocardiogr. Jan-Feb 1990;3(1):64-71. [Crossref]  [PubMed]
  22. Nakao M, Ch'ng JK, Sin YK, Chua YL, Lee CY. Acquired right-to-left shunt through an atrial septal perforation with cyanosis after percutaneous transvenous mitral commissurotomy. J Thorac Cardiovasc Surg. Mar 2008;135(3):690-1. [Crossref]  [PubMed]
  23. Korkmaz S, Demirkan B, Guray Y, Yilmaz MB, Sasmaz H. Long-term follow-up of iatrogenic atrial septal defect: after percutaneous mitral balloon valvuloplasty. Tex Heart Inst J. 2011;38(5):523-7. [PubMed]
  24. Rillig A, Meyerfeldt U, Kunze M, Birkemeyer R, Miljak T, Jäckle S, et al. Persistent iatrogenic atrial septal defect after a single-puncture, double-transseptal approach for pulmonary vein isolation using a remote robotic navigation system: results from a prospective study. Europace. Mar 2010;12(3):331-6. [Crossref]  [PubMed]
  25. Hammerstingl C, Lickfett L, Jeong KM, Troatz C, Wedekind JA, Tiemann K, et al. Persistence of iatrogenic atrial septal defect after pulmonary vein isolation--an underestimated risk? Am Heart J. Aug 2006;152(2):362 e1-5. [Crossref]  [PubMed]
  26. McGinty PM, Smith TW, Rogers JH. Transseptal left heart catheterization and the incidence of persistent iatrogenic atrial septal defects. J Interv Cardiol. Jun 2011;24(3):254-63. [Crossref]  [PubMed]
  27. Wiktor DM, Carroll JD. ASD Closure in Structural Heart Disease. Curr Cardiol Rep. Apr 17 2018;20(6):37. [Crossref]  [PubMed]
  28. Seferovic PM, Ristic AD, Imazio M, Maksimović R, Simeunović D, Trinchero R, et al. Management strategies in pericardial emergencies. Herz. Dec 2006;31(9):891-900. [Crossref]  [PubMed]
  29. Panneerselvam A, Ananthakrishna R, Srinivas BC, Setty SKH, Manjunath SC, Basavanna D, et al. Hemopericardium Following Transseptal Puncture During Balloon Mitral Valvotomy: Management Strategies and Outcomes. J Invasive Cardiol. Feb 2020;32(2):70-75. [Crossref]  [PubMed]
  30. Alkhouli M, Rihal CS, Holmes DR, Jr. Transseptal Techniques for Emerging Structural Heart Interventions. JACC Cardiovasc Interv. Dec 26 2016;9(24):2465-2480. [Crossref]  [PubMed]
  31. Steele J, Mamkin I, Worku B, Gulkarov I. Treatment of hemopericardium caused by mitral balloon valvuloplasty with activated factor VII: a case report. J Med Case Rep. Jan 28 2014;8:33. [Crossref]  [PubMed]  [PMC]
  32. Friedrich SP, Berman AD, Baim DS, Diver DJ. Myocardial perforation in the cardiac catheterization laboratory: incidence, presentation, diagnosis, and management. Cathet Cardiovasc Diagn. Jun 1994;32(2):99-107. [Crossref]  [PubMed]
  33. Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation. Mar 26 2002;105(12):1465-71. [Crossref]  [PubMed]
  34. Nair CK, Runco V, Everson GT, Boghairi A, Mooss AN, Mohiuddin SM, et al. Conduction defects and mitral annulus calcification. Br Heart J. Aug 1980;44(2):162-7. [Crossref]  [PubMed]  [PMC]
  35. Evora PR, Finzi LP, Haddad J, Secches AL, Ribeiro PJ, Vicente WV. [Complete heart block after percutaneous mitral valvotomy with Inoue balloon]. Arq Bras Cardiol. Mar 1996;66(3):149-52. [PubMed]
  36. Mate I, Sobrino JA, Calvo L, et al. [Atrioventricular block at the nodal level and block of an accessory pathway during percutaneous mitral valvuloplasty]. Rev Esp Cardiol. Jan 1990;43(1):56-8. [PubMed]
  37. Palacios I, Block PC, Brandi S, Blanco P, Casal H, Pulido JI, et al. Percutaneous balloon valvotomy for patients with severe mitral stenosis. Circulation. Apr 1987;75(4):778-84. [Crossref]  [PubMed]
  38. Carlson MD, Palacios I, Thomas JD, Rottman JN, Freeman CS, Block PC, et al. Cardiac conduction abnormalities during percutaneous balloon mitral or aortic valvotomy. Circulation. Jun 1989;79(6):1197-203. [Crossref]  [PubMed]
  39. Bayar N, Yuksel IO, Kus G, Arslan S. [Delayed cardiac asystole after percutaneous mitral balloon valvuloplasty]. Turk Kardiyol Dern Ars. Dec 2013;41(8):743-5. Perkutan mitral balon valvuloplasti sonrasi gec asistoli. [Crossref]  [PubMed]
  40. Kronzon I, Tunick PA, Glassman E, Slater J, Schwinger M, Freedberg RS. Transesophageal echocardiography to detect atrial clots in candidates for percutaneous transseptal mitral balloon valvuloplasty. J Am Coll Cardiol. Nov 1990;16(5):1320-2. [Crossref]  [PubMed]
  41. Nobuyoshi M, Arita T, Shirai S, Hamasaki N, Yokoi H, Iwabuchi M, et al. Percutaneous balloon mitral valvuloplasty: a review. Circulation. Mar 3 2009;119(8):e211-9. [Crossref]
  42. Meyers PM, Schumacher HC, Connolly ES, Jr., Heyer EJ, Gray WA, Higashida RT. Current status of endovascular stroke treatment. Circulation. Jun 7 2011;123(22):2591-601. [Crossref]  [PubMed]  [PMC]
  43. Shetkar SS, Parakh N, Singh B, Mishra NK, Ray R, Karthikeyan G, et al. Cardio-embolic stroke due to valve tissue embolization during percutaneous transseptal mitral commissurotomy (PTMC). Indian Heart J. Sep-Oct 2014;66(5):546-9. [Crossref]  [PubMed]  [PMC]
  44. Park JH, Lee G, Han JK, Kim SJ, Lee MM. Inadvertent embolic obstruction of abdominal aorta from left atrial thrombus after percutaneous mitral valvuloplasty. Cardiovasc Intervent Radiol. Dec 1990;13(6):351-3. [Crossref]  [PubMed]
  45. Romanelli MR, Thayer JA, Neumeister MW. Ischemic Pain. Clin Plast Surg. Apr 2020;47(2):261-265. [Crossref]  [PubMed]
  46. Li HL, Chan YC, Guo Z, Zhou R, Cheng SW. Endovascular Thrombus Aspiration and Catheter-Directed Thrombolysis for Acute Thromboembolic Renal Artery Occlusion. Vasc Endovascular Surg. Jul 2022;56(5):521-524. [Crossref]  [PubMed]
  47. Ricci MA, Trevisani GT, Pilcher DB. Vascular complications of cardiac catheterization. Am J Surg. Apr 1994;167(4):375-8. [Crossref]  [PubMed]
  48. Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, et al. Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. J Vasc Surg. May 1997;25(5):803-8; discussion 808-9. [Crossref]  [PubMed]
  49. Park BW, Park YW, Nam BD, Kwon SS. Right heart failure due to arteriovenous fistula after spine surgery treated with endovascular repair. Acta Cardiol. Sep 2023;78(7):846-847. [Crossref]  [PubMed]
  50. De Martino RR, Nolan BW, Powell RJ, Walsh DB, Stone DH. Stent graft repair of iatrogenic femoral arteriovenous fistula: a useful therapeutic approach in a hostile groin. Vasc Endovascular Surg. Jan 2010;44(1):40-3. [Crossref]  [PubMed]
  51. Sugiyama H, Asagai S. Detachable coil embolisation for iatrogenic femoral arteriovenous fistula in patients with CHDs. Cardiol Young. Oct 2021;31(10):1698-1700. [Crossref]  [PubMed]