The role of three dimensional transesophageal echocardiography novel score in the success of redo percutaneous mitral balloon valvuloplasty
Authors: Memic Sancar K , Babur Guler G , Tasbulak O , Tanboga HI , Demir AR , Sahin AA , Tukenmez Karakurt S , Aktemur T , Avci Y , Bulut U , Tekin M , Guler E , Kalkan AK , Erturk M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Mitral valve morphology is traditionally evaluated according to the images of two-dimensional transthoracic echocardiography and Wilkins score (WS) criteria in the selection of suitable patients for Percutaneous balloon mitral valvuloplasty (PBMV). However, WS does not include mitral commissural morphology, it is known that not only WS but mitral valve commissure morphology is also important in the success of PBMV. It is known that mitral stenosis might develop secondary to the progression of the disease in the follow-up of the patients after first PBMV, and there are a limited knowledge about outcome and success in terms of redo PBMV.

Purpose
We aimed to determine whether WS in redo PMBV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure.

Methods
Our study designed as a retrospective, single center study. Fifty patients who underwent redo PMBV were included in the study. The patients were divided into two groups according to the success of the Redo PMBV procedure which was defined as post-procedural Mitral valve area (MVA) ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation immediately after Redo PMBV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PMBV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated.

Results
In the study group, 36 patients (72%) had successful redo PMBV procedure. WS was 8 (IQR 7 - 9) and novel 3D TEE score was found 4 (IQR 3 - 4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). According to these findings; when both models were compared, the predictive accuracy and performance of the model developed with novel 3D TEE score to predict procedural success was found to be more favorable than the model developed with WS. When the probability of procedural success was calculated according to novel 3D TEE score using univariable logistic regression analysis, the probability of procedural successes was calculated &gt; 90%, especially when novel 3D TEE score was &lt;4.

Conclusion
The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PMBV, especially in patients who are considered for surgery due to the high WS. Abstract Figure. Definition of novel 3D TEE scoring Abstract Figure. Information about novel 3D TEE scoring