Emergency surgery after percutaneous transmitral commissurotomy: Operative versus echocardiographic findings, mechanisms of complications, and outcomes

Praveen Kerala Varma, Sanjay Theodore, Praveen Kumar Neema, Padmakumar Ramachandran, Harikrishnan Sivadasanpillai, Krishna Kumar Nair, Kurur Sankaran Neelakandhan

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: This study was undertaken to determine the clinical profile of patients undergoing emergency surgery after balloon mitral valvotomy, to note operative findings and compare them with those of transthoracic echocardiography, to describe the mechanisms of complications, and to describe outcomes. Methods: A retrospective study was undertaken of patients requiring emergency surgery after percutaneous mitral valvotomy with an Inoue balloon from January 1990 to December 2003. The data analyzed included demographic variables, causes and clinical presentations of complications, and outcome. In 14 consecutive cases of mitral regurgitation, an observational study comparing the operative findings with echocardiography was also undertaken. Results: In 1388 cases of valvotomy, complications necessitating urgent surgery occurred in 31 cases (2.2%). Acute mitral regurgitation occurred in 23 cases (74.2 %), and cardiac tamponade occurred in 8 cases (25.8%). Mitral regurgitation was due to leaflet tearing in all cases: anterior leaflet in 20 cases and posterior leaflet in 3 cases. Hypotension, orthopnea, and pulmonary edema were the clinical presentation for mitral regurgitation. Transthoracic echocardiography underestimated the severity of mitral valve pathology. Bilateral severe commissural fusion and pliable leaflet with paracommissural calcium was seen in anterior leaflet tearing. Cardiac tamponade with hemodynamic compromise occurred as a result of left atrial perforation in 6 cases, right atrial perforation in 1 case, and left ventricular perforation in 1 case. High septal puncture led to atrial perforation. Operative mortality was 9.6%, and low cardiac output developed in 29%. Conclusion: Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology.

Original languageEnglish
Pages (from-to)772-776
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume130
Issue number3
DOIs
Publication statusPublished - 01-09-2005

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Mitral Valve Insufficiency
Emergencies
Cardiac Tamponade
Echocardiography
Balloon Valvuloplasty
Pathology
Low Cardiac Output
Pulmonary Edema
Mitral Valve
Punctures
Hypotension
Observational Studies
Retrospective Studies
Hemodynamics
Demography
Calcium
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Varma, Praveen Kerala ; Theodore, Sanjay ; Neema, Praveen Kumar ; Ramachandran, Padmakumar ; Sivadasanpillai, Harikrishnan ; Nair, Krishna Kumar ; Neelakandhan, Kurur Sankaran. / Emergency surgery after percutaneous transmitral commissurotomy : Operative versus echocardiographic findings, mechanisms of complications, and outcomes. In: Journal of Thoracic and Cardiovascular Surgery. 2005 ; Vol. 130, No. 3. pp. 772-776.
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abstract = "Objective: This study was undertaken to determine the clinical profile of patients undergoing emergency surgery after balloon mitral valvotomy, to note operative findings and compare them with those of transthoracic echocardiography, to describe the mechanisms of complications, and to describe outcomes. Methods: A retrospective study was undertaken of patients requiring emergency surgery after percutaneous mitral valvotomy with an Inoue balloon from January 1990 to December 2003. The data analyzed included demographic variables, causes and clinical presentations of complications, and outcome. In 14 consecutive cases of mitral regurgitation, an observational study comparing the operative findings with echocardiography was also undertaken. Results: In 1388 cases of valvotomy, complications necessitating urgent surgery occurred in 31 cases (2.2{\%}). Acute mitral regurgitation occurred in 23 cases (74.2 {\%}), and cardiac tamponade occurred in 8 cases (25.8{\%}). Mitral regurgitation was due to leaflet tearing in all cases: anterior leaflet in 20 cases and posterior leaflet in 3 cases. Hypotension, orthopnea, and pulmonary edema were the clinical presentation for mitral regurgitation. Transthoracic echocardiography underestimated the severity of mitral valve pathology. Bilateral severe commissural fusion and pliable leaflet with paracommissural calcium was seen in anterior leaflet tearing. Cardiac tamponade with hemodynamic compromise occurred as a result of left atrial perforation in 6 cases, right atrial perforation in 1 case, and left ventricular perforation in 1 case. High septal puncture led to atrial perforation. Operative mortality was 9.6{\%}, and low cardiac output developed in 29{\%}. Conclusion: Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology.",
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Emergency surgery after percutaneous transmitral commissurotomy : Operative versus echocardiographic findings, mechanisms of complications, and outcomes. / Varma, Praveen Kerala; Theodore, Sanjay; Neema, Praveen Kumar; Ramachandran, Padmakumar; Sivadasanpillai, Harikrishnan; Nair, Krishna Kumar; Neelakandhan, Kurur Sankaran.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 130, No. 3, 01.09.2005, p. 772-776.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Emergency surgery after percutaneous transmitral commissurotomy

T2 - Operative versus echocardiographic findings, mechanisms of complications, and outcomes

AU - Varma, Praveen Kerala

AU - Theodore, Sanjay

AU - Neema, Praveen Kumar

AU - Ramachandran, Padmakumar

AU - Sivadasanpillai, Harikrishnan

AU - Nair, Krishna Kumar

AU - Neelakandhan, Kurur Sankaran

PY - 2005/9/1

Y1 - 2005/9/1

N2 - Objective: This study was undertaken to determine the clinical profile of patients undergoing emergency surgery after balloon mitral valvotomy, to note operative findings and compare them with those of transthoracic echocardiography, to describe the mechanisms of complications, and to describe outcomes. Methods: A retrospective study was undertaken of patients requiring emergency surgery after percutaneous mitral valvotomy with an Inoue balloon from January 1990 to December 2003. The data analyzed included demographic variables, causes and clinical presentations of complications, and outcome. In 14 consecutive cases of mitral regurgitation, an observational study comparing the operative findings with echocardiography was also undertaken. Results: In 1388 cases of valvotomy, complications necessitating urgent surgery occurred in 31 cases (2.2%). Acute mitral regurgitation occurred in 23 cases (74.2 %), and cardiac tamponade occurred in 8 cases (25.8%). Mitral regurgitation was due to leaflet tearing in all cases: anterior leaflet in 20 cases and posterior leaflet in 3 cases. Hypotension, orthopnea, and pulmonary edema were the clinical presentation for mitral regurgitation. Transthoracic echocardiography underestimated the severity of mitral valve pathology. Bilateral severe commissural fusion and pliable leaflet with paracommissural calcium was seen in anterior leaflet tearing. Cardiac tamponade with hemodynamic compromise occurred as a result of left atrial perforation in 6 cases, right atrial perforation in 1 case, and left ventricular perforation in 1 case. High septal puncture led to atrial perforation. Operative mortality was 9.6%, and low cardiac output developed in 29%. Conclusion: Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology.

AB - Objective: This study was undertaken to determine the clinical profile of patients undergoing emergency surgery after balloon mitral valvotomy, to note operative findings and compare them with those of transthoracic echocardiography, to describe the mechanisms of complications, and to describe outcomes. Methods: A retrospective study was undertaken of patients requiring emergency surgery after percutaneous mitral valvotomy with an Inoue balloon from January 1990 to December 2003. The data analyzed included demographic variables, causes and clinical presentations of complications, and outcome. In 14 consecutive cases of mitral regurgitation, an observational study comparing the operative findings with echocardiography was also undertaken. Results: In 1388 cases of valvotomy, complications necessitating urgent surgery occurred in 31 cases (2.2%). Acute mitral regurgitation occurred in 23 cases (74.2 %), and cardiac tamponade occurred in 8 cases (25.8%). Mitral regurgitation was due to leaflet tearing in all cases: anterior leaflet in 20 cases and posterior leaflet in 3 cases. Hypotension, orthopnea, and pulmonary edema were the clinical presentation for mitral regurgitation. Transthoracic echocardiography underestimated the severity of mitral valve pathology. Bilateral severe commissural fusion and pliable leaflet with paracommissural calcium was seen in anterior leaflet tearing. Cardiac tamponade with hemodynamic compromise occurred as a result of left atrial perforation in 6 cases, right atrial perforation in 1 case, and left ventricular perforation in 1 case. High septal puncture led to atrial perforation. Operative mortality was 9.6%, and low cardiac output developed in 29%. Conclusion: Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology.

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