Effects of balloon mitral valvuloplasty on left atrial function in mitral stenosis as assessed by pressure-area relation

J Am Coll Cardiol. 1998 Jul;32(1):159-68. doi: 10.1016/s0735-1097(98)00178-8.


Objectives: This study sought to investigate the changes induced on the pressure-area relation of the left atrium in patients with mitral stenosis after percutaneous balloon mitral valvuloplasty.

Background: Left atrial (LA) function is influenced by changes in LA afterload. The latter is increased in mitral stenosis as a result of increased resistance to blood flow imposed by the stenotic mitral valve.

Methods: We studied the effects of acute alterations of LA afterload induced by retrograde nontransseptal balloon mitral valvuloplasty (RNBMV) on LA function in patients with mitral stenosis. LA pressure-area relations were obtained in 15 patients with mitral stenosis (8 with sinus rhythm, 7 with atrial fibrillation) before and after valvuloplasty, as well as in 15 normal subjects. LA pressure was recorded by a catheter-tipped micromanometer introduced retrogradely into the left atrium while LA area was recorded simultaneously using acoustic quantification. The areas of the A and V loops of the pressure-area relation as well as the LA chamber stiffness constant were calculated.

Results: Balloon valvuloplasty resulted in a significant increase in mitral valve area (p < 0.001) and a substantial reduction of the mean transmitral pressure gradient (p < 0.001) and mean LA pressure (p < 0.001). The area of the A loop in patients with sinus rhythm and the area of the V loop in those with atrial fibrillation increased significantly after completion of the procedure (p < 0.001). Furthermore, LA stiffness decreased in both groups.

Conclusions: After RNBMV, there is a significant increase in LA pump function in patients with sinus rhythm, a significant increase in LA reservoir function in patients with atrial fibrillation and a significant reduction in LA stiffness in all patients. Marked alterations of the configuration of the LA pressure-area relation occur immediately after successful RNBMV in patients with mitral stenosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Atrial Function, Left / physiology*
  • Blood Pressure / physiology
  • Echocardiography
  • Electrocardiography
  • Female
  • Hemodynamics / physiology
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Stenosis / physiopathology
  • Mitral Valve Stenosis / therapy*
  • Treatment Outcome