Valvuloplasty: benefits for low-flow, low-gradient mitral stenosis are unclear

  • El Sabbagh A & al.
  • J Am Heart Assoc
  • 5 Mar 2019

  • International Clinical Digest
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  • Patients with low-gradient (LG) mitral stenosis (MS) experience less benefit from valvuloplasty than those with high-gradient (HG) MS.
  • These patients may have low-flow (LF) or normal-flow MS. 
  • Symptoms in patients with LF/LG MS may be driven by arterial stiffness, ventricular-vascular uncoupling, Afib, decreased left ventricular compliance.
  • Mitral gradient predicted valvuloplasty response.

Why this matters

  • It has been unclear whether valvuloplasty benefits patients with LG, functionally severe MS.

Key results

  • Compared with HG group, LG group's differences included:
    • Higher left ventricular end-diastolic pressure (LVEDP) and
    • Less abnormal mean pulmonary artery pressure, pulmonary vascular resistance, and mitral valve area.
  • Compared with HG group, after valvuloplasty, LG group experienced: 
    • Less decrease in mitral gradient and left atrial (LA) pressure (P=.003). 
    • Less frequent symptom improvement, with 40% of LG group experiencing no improvement vs 18% of HG group (P=.02).
    • Worse survival.
  • Predictors of poor valvuloplasty response: 
    • Gradient
    • LVEDP >15 mmHg.
    • Higher ventricular stiffness. 
  • Nonpredictors included mitral valve area, baseline LA pressure. 

Study design

  • Cross-sectional study of patients with severe rheumatic MS undergoing balloon valvuloplasty, cardiac catheterization (n=101).
  • Authors assessed clinical and echocardiographic characteristics, post-valvuloplasty outcomes.
  • Funding: None disclosed.


  • Selection bias.
  • Results might not generalize to those with calcific degenerative MS.
  • Causation not determined. 

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