Advantage of Color Doppler Flow Imaging in the Assessment of Mitral Regurgitation and Atrial Septal Defect after Percutaneou Mitral Valvotomy

Doppler echocardiography and color Doppler flow imaging were used to assess the results of percutaneous mitral valvotomy in 293 consecutive patients aged 16-86 years (mean age 52.4 ± 13.5). Doppler examinations were performed the day before as well as within 2 days and 3 months after valvotomy. The first 161 procedures were carried out using the double-balloon technique and the last 132 using the Inoue technique. Mitral valve area, calculated according to the Gorlin formula, increased on average from 1.0 ± 0.3 to 2.0 ± 0.5 cm^2 (p < 0.0001) and the mean gradient dropped on average from 12.5 ± 4 to 5 ± 2 mm Hg (p < 0.0001). Grade 1+ mitral regurgitation was present in 85 patients (29%) before valvotomy when estimated from left ventricular angiography. After valvotomy, it worsened to grade 2+ in 19 patients (6%) and to grade 3+ or 4+ in 5 cases (1.7%). Grade 1+, 2+ and 3+ mitral regurgitation appeared in 28 (9.5%), 5 (1.7%) and 6 patients (2%), respectively. Grade 1+ mitral regurgitation was detected by color Doppler in 159 patients (54%) before valvotomy. After the procedure, it worsened to grade 2+ in 16 patients (5%) and to grade 3+ or 4+ in 5 patients (1.7%). Grade 1+, 2+ and 3+ mitral regurgitation appeared in 30 (10%), 6 (2%) and 2 (0.7%) patients, respectively. Mitral regurgitation disappeared after valvotomy in 21 patients (7.2%). The specificity of color Doppler in the detection of mitral regurgitation was questionable when compared to contrast angiography (44%), perhaps because color Doppler may be more sensitive than left ventriculography in the diagnosis of mild mitral regurgitation. All in all, mitral regurgitation quantification determined by color Doppler correlated well with contrast angiography data, with a discrepancy of more than 1 grade in only 6 patients. The location and mechanism of mitral regurgitation were determined using color Doppler. Regurgitation was central in most cases; it was sometimes located on one commissure or on both in 26 cases. Color Doppler visualized an atrial septal defect in 115 patients (39%) on day 2, which persisted in 36 of 96 patients reexamined 3 months later. A shunt inversion was present during deep inhalation in 1 case. No correlation was found between the persistence or disappearance of the shunt and the results of mitral valvotomy.