Long-Term (Up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in Children in Comparison with Adult Population

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Abstract

Aims

The purpose of this study was to assess the safety, efficacy, and long-term results (up to 18 years) of mitral balloon valvuloplasty (MBV) in children in comparison to adults.

Methods

57 children age ≤ 18 years (group A) and 474 adult patients (group B) who underwent successful MBV and were followed up for a mean 8.5 ± 4.8 (range 1.5–18) years were analyzed.

Results

Patients in group A had a lower mitral echocardiographic score (echo score), 7.6 ± 1.3 vs. 8.1 ± 1 (P = 0.0005); smaller Doppler mitral valve area (MVA), 0.82 ± 0.16 cm2 vs. 0.92 ± 0.17 cm2 (P < 0.0001); and higher mitral valve gradient, 15.2 ± 2.3 mmHg vs. 14.3 ± 2.1 mmHg (P = 0.0003), than group B. Immediately after MBV, group A had larger MVA whether measured by catheter, 1.99 ± 0.57 cm2 vs. 1.8 ± 0.52 cm2 (P < 0.001), or by Doppler, 2.0 ± 0.27 cm2 vs. 1.97 ± 0.28 cm2 (P < 0.01), and similar complication rates, compared to group B. After a mean follow-up of 8.5 ± 4.8 (range 1.5–18 years), restenosis in group A was 26% vs. 31% for group B (P = 0.41). Echo score > 8 (P = 0.046) was a predictor of restenosis in children and echo score > 8 (P < 0.0001) and previous surgery (P = 0.043) were predictors of restenosis in adults. Actuarial freedom from restenosis at 10, 15, and 18 years for groups A and B were 78% ± 7%, 64% ± 9%, and 18% ± 14% and 77% ± 2%, 43% ± 4%, and 17% ± 4%, respectively (P = 0.26). Event-free survival rates at 10, 15, and 18 years were 87% ± 6%, 62% ± 1%, and 20% ± 2% versus 87% ± 1%, 51% ± 4%, and 20% ± 5% for groups A and B, respectively (P = 0.51). Postprocedure MVA < 2.0 cm2 (P = 0.043) and previous surgery (P = 0.03) were identified as predictors of events in children. Echo score > 8 (P < 0.0001) and prevalvuloplasty AF (P = 0.03) were identified as predictors of events in adults.

Conclusion

MBV is safe and effective in children with rheumatic MS. It provides better immediate results than in adults and excellent long-term results that are comparable to those seen in adults.

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