Right ventricular function outcomes of percutaneous balloon mitral valvuloplasty: a 3-dimensional echocardiography and 2-dimensional speckle tracking analysis
Authors: Mosa E H A B E , Abd Elkareem T A H E R , Marghany Mhgoub K A M A L , Abd Almagid A L I M 
Published: January 2025

Abstract

Background
Rheumatic heart disease (RHD) is a significant cause of mitral stenosis (MS), particularly affecting young adults in developing regions. Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a recognized intervention for severe symptomatic mitral stenosis with favorable morphology. However, its impact on various cardiac parameters needs thorough evaluation by new imaging techniques to increase measurement accuracy and decrease inter-observer variability.

Purpose
This study aims to evaluate the impact of PBMV on cardiac function and structure among patients with severe rheumatic mitral stenosis, focusing on mitral valve function, Pulmonary artery systolic pressure (PASP) and right ventricular (RV) parameters.

Methods
A prospective study was conducted involving 30 patients (80% female, mean age 33.1 years) diagnosed with severe rheumatic mitral stenosis. All participants underwent PBMV. Pre- and 30 days post-procedure assessments included conventional echocardiographic parameters, three-dimensional (3D) RV assessment and two-dimensional (2D) strain RV analysis. Statistical analyses were performed to determine significant changes post-PBMV.

Results
Echocardiographic evaluation showed a decrease in trans-mitral mean pressure gradient and Pressure Half Time (both P&lt;0.001). Improvements were also noted in 2D and 3D mitral valve planimetry values (P&lt;0.001). However, mitral regurgitation (MR) severity increased in some cases (P=0.022). Regarding right ventricular analysis, significant reductions were observed in RV basal, mid and longitudinal diameters (P&lt;0.001 for all). RV Fractional Area Change (FAC%) increased significantly (P&lt;0.001). TAPSE also showed a significant increase (P&lt;0.001), reflecting improved RV functional performance. PASP and TR severity both showed marked reductions (P&lt;0.001), whereas a subgroup analysis indicated that patients with atrial fibrillation (AF) had a less pronounced decrease in PASP compared to those with sinus rhythm. Strain analysis revealed substantial improvements in RV strain parameters, with significant increases in basal, mid, apical, and mean (RVFW) free wall strain (P&lt;0.001) and RV global longitudinal strain (RV GLS) (P&lt;0.001). 3D echocardiography demonstrated significant decreases in RV end-systolic volume (P=0.004) and marked increases in RV EF ejection fraction (P&lt;0.001) and stroke volume (P&lt;0.001), while end-diastolic volume showed no significant change (P=0.061). the study demonstrates that the decline in PASP can significantly predict improvements in both 2D and 3D RV function parameters following PBMV.

Conclusion
RV performance showed substantial improvement early post-PBMV, as evidenced by marked increases in 3D right ventricular ejection fraction (3DRVEF), right ventricular free wall (RVFW) strain, and RV global longitudinal strain. These enhancements were significantly predicted by the reduction in pulmonary artery systolic pressure (PASP).
RV conventional Echocardiographic Parame
RV 3D echocardiography and 2D speckle tr