Long-term follow-up of iatrogenic atrial septal defect: after percutaneous mitral balloon valvuloplasty

Tex Heart Inst J. 2011;38(5):523-7.

Abstract

During percutaneous mitral balloon valvuloplasty, the Inoue method leaves patients with an iatrogenic atrial septal defect. In this study, we evaluated the factors affecting the development of iatrogenic atrial septal defect and searched for the possible influence of this defect on long-term outcomes.We reviewed the medical records of 267 patients who had undergone successful percutaneous mitral balloon valvuloplasty for symptomatic moderate or severe mitral stenosis from January 2000 through March 2004. Sixty-three of the 267 patients were enrolled in a face-to-face follow-up study. We noted their clinical and demographic characteristics. All included patients were asked for the endpoints of repeat percutaneous mitral balloon valvuloplasty or mitral valve surgery, cerebrovascular accident or transient ischemic attack, and the need of intervention for the iatrogenic atrial septal defect. They underwent standard 2-dimensional and Doppler echocardiographic examination. The presence of iatrogenic atrial septal defect was evaluated via the color-Doppler technique in the subcostal view and via contrast echocardiography.Patients were subclassified in accordance with the presence (n = 15) or absence (n = 48) of echocardiographically proven persistent iatrogenic atrial septal defect. When we compared the 2 groups, there were no significant differences in baseline demographic characteristics or in pre- and postprocedural echocardiographic data.We conclude that the presence of persistent iatrogenic atrial septal defects might not be predicted from echocardiographic or demographic data in patients undergoing percutaneous mitral balloon valvuloplasty. Fortunately, these defects are small in size and low in shunt ratio. They appear not to be associated with serious long-term outcomes.

Keywords: Balloon dilation; follow-up studies; heart atria; heart catheterization; heart septal defects, atrial/etiology; heart septum/injuries; iatrogenic disease; mitral valve stenosis/therapy; postoperative complications; punctures/adverse effects; valvuloplasty, percutaneous mitral balloon.

MeSH terms

  • Adult
  • Atrial Septum / diagnostic imaging
  • Atrial Septum / injuries
  • Catheterization / adverse effects*
  • Chi-Square Distribution
  • Contrast Media
  • Echocardiography, Doppler, Color
  • Female
  • Heart Injuries / diagnostic imaging
  • Heart Injuries / etiology*
  • Humans
  • Iatrogenic Disease*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mitral Valve Stenosis / therapy*
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Turkey

Substances

  • Contrast Media