Acute severe mitral regurgitation with cardiogenic shock following balloon mitral valvuloplasty: echocardiographic findings and outcomes following surgery

  • Ajith Ananthakrishna PillaiEmail author
  • Vidhyakar Rangaswamy Balasubramonian
  • Hemachandren Munuswamy
  • Shabnasri Seenuvaslu
Original Article


Acute severe mitral regurgitation (MR) is the commonest indication for emergency surgery following a balloon mitral valvuloplasty (BMV). It results in hemodynamic compromise with cardiogenic shock and or acute pulmonary edema. These patients deteriorate fast and often require respiratory and critical care support, followed by urgent mitral valve replacement (MVR). We analyzed the data of 1224 BMV procedures done over the 18-year period. We had 85 patients (6.9%) with acute severe MR and cardiogenic shock. The clinical profile, echocardiographic features and operative findings were studied. The echocardiography scores were compared for association with occurrence of MR. The immediate and long-term clinical outcomes of these acutely sick patients were studied. Of the 85 patients, 84 underwent MVR. Anterior mitral leaflet tear was observed in 65 (75%) cases, para-commissural with annular tear in 8 (9.4%), Chordal injury in 7 (8%) and torn posterior leaflet in 5 (5.8%). We documented severe MR in 88 patients (7.1%), with 85 (6.9%) among them developing features of cardiogenic shock. None of the echocardiographic scoring systems were predictive of the occurrence of MR. The 30-day mortality was 4.7%. The mean clinical follow-up period after discharge was 9.3 ± 0.9 years (range 2.2–17.8) with no late mortality. Acute severe MR had an incidence of 7% in this study. Injury to the anterior mitral leaflet was the commonest cause. The long-term outcomes were good with timely intervention and valve replacement surgery despite the fact that the majority (96%) presented with cardiogenic shock. None of the present valve scoring systems could predict the occurrence of severe MR.


Mitral stenosis Mitral valvuloplasty Mitral regurgitation Cardiogenic shock 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Nanjappa MC, Ananthakrishna R, Hemanna Setty SK, Bhat P, Shankarappa RK, Panneerselvam A. Acute severe mitral regurgitation following balloon mitral valvotomy: echocardiographic features, operative findings, and outcome in 50 surgical cases. Catheter Cardiovasc Interv. 2013;81(4):603–8. Scholar
  2. 2.
    Varma PK, Theodore S, Neema PK, Ramachandran P, Sivadasanpillai H, Nair KK, Neelakandhan KS. Emergency surgery after percutaneous trans mitral commissurotomy: operative versus echocardiographic findings, mechanisms of complications, and outcomes. J Thorac Cardiovasc Surg. 2005;130:772–6.CrossRefGoogle Scholar
  3. 3.
    Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988;60(4):299–308.CrossRefGoogle Scholar
  4. 4.
    Abascal VM, Wilkins GT, Choong CY, Thomas JD, Palacios IF, Block PC, Weyman AE. Echocardiographic evaluation of mitral valve structure and function in patients followed for at least 6 months after percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol. 1988;12:606–15.CrossRefGoogle Scholar
  5. 5.
    Essop Mohammed R, Wisenbaugh Thomas, Skoularigis John, Middlemost Shirley, Sareli Pinhas. Mitral regurgitation following mitral balloon valvotomy differing mechanisms for severe versus mild-to-moderate lesions. Circulation. 1991;84:1669–79.CrossRefGoogle Scholar
  6. 6.
    Vahanian A. Balloon valvuloplasty. Heart. 2001;85(2):223–8.CrossRefGoogle Scholar
  7. 7.
    Kaul UA, Singh S, Kalra GS, Nair M, Mohan JC, Nigam M, Arora R. Mitral regurgitation following percutaneous transvenous mitral commissurotomy: a single-center experience. J Heart Valve Dis. 2000;9(2):262–6 (discussion 266–8).Google Scholar
  8. 8.
    Kim MJ, Song JK, Song JM, Kang DH, Kim YH, Lee CW. Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty. Circulation. 2006;114(25):2815–22.CrossRefGoogle Scholar
  9. 9.
    Harrison JK, Wilson JS, Hearne SE, Bashore TM. Complications related to percutaneous transvenous mitral commissurotomy. Catheter Cardiovasc Diagn. 1994;Suppl 2:52–60.Google Scholar
  10. 10.
    Aslanabadi N, Toufan M, Salehi R, Alizadehasl A, Ghaffari S, Sohrabi B. Mitral regurgitation after percutaneous balloon mitral valvotomy in patients with rheumatic mitral stenosis: a single-center study. J Tehran Heart Cent. 2014;9(3):109–14.Google Scholar
  11. 11.
    Padial LR, Freitas N, Sagie A, Newell JB, Weyman AE, Levine RA, Palacios IF. Echocardiography can predict which patients will develop severe mitral regurgitation after percutaneous mitral valvulotomy. J Am Coll Cardiol. 1996;27(5):1225–31.CrossRefGoogle Scholar
  12. 12.
    Nobuyoshi M, Hamasaki N, Kimura T, et al. Indications, complications, and short-term clinical outcome of percutaneous trans venous mitral commissurotomy. Circulation. 1989;80(4):782–92.CrossRefGoogle Scholar
  13. 13.
    Reid CL, Chandraratna PA, Kawanishi DT, et al. Influence of mitral valve morphology on double-balloon catheter balloon valvuloplasty in patients with mitral stenosis. Analysis of factors predicting immediate and 3-month results. Circulation. 1989;80(3):515–24.CrossRefGoogle Scholar
  14. 14.
    Chen CG, Wang X, Wang Y, et al. Value of two-dimensional echocardiography in selecting patients and balloon sizes for percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol. 1989;14(7):1651–8.CrossRefGoogle Scholar
  15. 15.
    Roth RB, Block PC, Palacios I. Predictors of increased mitral regurgitation after percutaneous mitral balloon valvotomy. Catheter Cardiovasc Diagn. 1990;20(1):17–21.CrossRefGoogle Scholar
  16. 16.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014;129(23):2440–92.CrossRefGoogle Scholar
  17. 17.
    Lung B, Cormier B, Ducimetiere P, et al. Immediate results of percutaneous mitral commissurotomy. A predictive model on a series of 1514 patients. Circulation. 1996;94(9):2124–30.CrossRefGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2018

Authors and Affiliations

  1. 1.Department of CardiologyJIPMERPuducherryIndia
  2. 2.Department of Cardiac SurgeryJIPMERPuducherryIndia

Personalised recommendations