Urgent balloon mitral valvotomy in acute refractory pulmonary edema

Objectives The present study was performed to determine the outcome of emergent balloon mitral valvotomy (BMV) in patients with refractory pulmonary edema. Methods Of 1776 patients undergoing BMV between 1986 and 2004, 17 patients presented with refractory pulmonary edema to medical treatment underwent emergent BMV. Results Age (mean +/− SD) 29 +/− 10.5 years, incidence of atrial fibrillation (30%), pulmonary artery systolic pressure (PAsP) (79 +/− 17 mm Hg), mitral valve (MV) score (8.6 +/− 2.9) and MV area (0.7 +/− 0.19 cm2). After the procedure, minimal mitral regurgitation occurred in 20%, and mortality rate was 11%. Follow-up of 4.5 +/− 2 years was available in 14 of 15 survivors, of whom 11 were asymptomatic. The gain in MV area and the decrease in transmitral gradient (TMG) and PAsP persisted during the follow-up period. Conclusion Emergent BMV is safe and feasible in patients with symptomatic mitral stenosis and severe pulmonary edema refractory to medical therapy. Survivors have excellent clinical and hemodynamic status at follow-up.