Since its introduction in 1984, mitral catheter balloon valvuloplasty (CBV) has become recognized as a promising investigational treatment that could become an alternative to surgical commissurotomy in selected patients with mitral valve stenosis. Early reports documented the clinical and hemodynamic benefits of CBV as well as the expected procedure-related risks. The increasing interest in mitral CBV techniques has resulted in broadening application of these procedures to adult patients. Therefore, this review summarizes the clinical diagnosis of mitral stenosis, the current techniques of performing mitral CBY the immediate hemodynamic and clinical results, and, more important, the potential risks and benefits of CBV in various types of patients who might be referred for this treatment. read more
Diagnosis of Mitral Stenosis
The classic presentation of a patient with rheumatic mitral stenosis is a woman between 20 and 45 years of age with progressive dyspnea on exertion. Patients may also present in acute pulmonary edema precipitated by pregnancy, a febrile illness, or the sudden onset of atrial fibrillation. The physical findings of mitral stenosis include a loud first heart sound, an opening snap, and a diastolic rumble heard with presystolic accentuation at the apex. The presence of an opening snap and a loud first heart sound indicate a pliable mitral valve. A loud pulmonic component of the second heart sound (P2), transmitted down the left sternal border, is associated with increased pulmonary arterial pressures.
Elderly patients with calcific mitral stenosis usually have progressive fatigue and dyspnea. The physical findings are usually a diastolic rumble, the lack of an opening snap, the presence of associated murmurs of mitral or tricuspid regurgitation, a loud P2, and a right ventricular lift.