Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: The Decision To Refer Patients for Mitral CBV
The presence of complex or multiple severe valve lesions will usually require surgical treatment. Simply increasing the mitral valve area in a patient with complex valve lesions may not effectively alter the patients hemodynamic or clinical status. Evaluation of mitral valve morphology including calcification, pliability, and the severity of subvalvular disease may also help to anticipate the degree of increase of mitral valve area.
Information regarding the patients age and general clinical condition and the presence of concomitant significant neurologic or systemic diseases should be assessed to determine a patients procedure-related risks, the overall therapeutic goals, and the potential impact that a successful CBV might make on the patients clinical condition. http://antimicrobialmed.com/
Once this information is available, the patient and family and the primary care physicians should discuss several questions: (1) Is either a surgical intervention or CBV indicated? (2) What is the increase in mitral valve area that is likely to be achieved by surgery or by CBV at a particular institution? (3) What are the relative risks of medical treatment, of surgical intervention, or of CBV at a particular institution? (4) What are the primary physicians therapeutic goals for a particular patient and what is the physicians treatment preference? (5) What are the patient and family’s goals and preferences, having been informed of all the above options?
To gather data on this complex issue the National Heart, Lung, and Blood Institute has initiated a balloon valvuloplasty registry that will record the immediate results and two-year follow-up of all adult patients having aortic, mitral, and pulmonic CBV in the participating registry centers over the next two years. The collective experience in these centers should provide clinicians and patients with additional information regarding the long-term results of CBV treatment of patients with mitral valve stenosis.