Left atrial structural and functional remodeling following balloon mitral valvuloplasty
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ORIGINAL PAPER
Left atrial structural and functional remodeling following balloon mitral valvuloplasty Amir Anwar Samaan1,2 · Ahmed Hassan1,2 · Mohamed Hassan1,2 · Karim Said1 · Wafaa El Aroussy1 · Mohamed Eid Fawzy1 · Magdi Yacoub3,4 Received: 7 July 2020 / Accepted: 21 October 2020 © Springer Nature B.V. 2020
Abstract Mitral stenosis (MS) is associated with left atrial (LA) functional and morphological changes as a result of chronic increase in LA pressure. Relieving the mitral obstruction via balloon mitral valvuloplasty (BMV) might be associated with LA structural and functional remodeling. To study alterations of LA volume and functions 1 year following successful BMV in patients with isolated rheumatic severe mitral stenosis. Thirty patients (median age 33 years, 22 women) with severe rheumatic MS were included in the study. Using biplane method, trans-thoracic 2D echocardiography was used to estimate LA volume indexed to body surface area (BSA). Maximal, minimal and pre-A left atrial volumes were measured and indexed to BSA. LA volumetric functions were then assessed and the measurements were repeated 6 months and 1 year after successful valvuloplasty. At baseline, median mitral valve area (MVA) was 0.9 (0.6–1.3) cm2 measured by planimetry with a mean pressure gradient of 12.5 (8–24) mmHg. Following BMV, a significant regression of left atrial volume index was noticed at 6 months compared to baseline (51 vs. 60 ml/m2, p = 0.001) with a further decrease at 1 year (48 vs. 51 ml/m2, p = 0.03). At 6 months, volumetric assessment of left atrial functions showed a significant improvement in LA total emptying fraction (42% vs 30%, p = 0.001) as well as in LA passive emptying fraction (26% vs 14%, p = 0.033) and LA active emptying fraction (20% vs. 18%, p = 0.016). All these indices showed further improvement at 1 year [47% (P = 0.02), 29% (p = 0.03) and 31% (p = 0.001) respectively]. In patients with isolated rheumatic MS, mitral valvuloplasty was associated with a significant decline of LA volume accompanied by a significant improvement of its volumetric functions. Keywords Left atrial volume · Left atrial function · Balloon mitral valvuloplasty · Rheumatic mitral stenosis
Introduction As the prevalence and incidence of rheumatic heart disease (RHD) have markedly decreased in the developed world, the progress in the research field of the disease has been remarkably slow over the past two decades. In fact, in the current era, RHD is still considered one of the major threats * Amir Anwar Samaan [email protected]; [email protected] 1
Department of Cardiovascular Medicine, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
2
Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
3
Department of Cardiothoracic Surgery, Aswan Heart Centre, Aswan, Egypt
4
Department of Cardiothoracic Surgery, Imperial College London, London, UK
facing the developing world. It was estimated that nearly thirty million children and young adults suffer from chronic RHD worldwide [1]. T
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