Mohamed Shoukri

Long-term effects of balloon angioplasty on left ventricular hypertrophy in adolescent and adult patients with native coarctation of the aorta. Up to 18 years follow-up results.

Little is known regarding the long‐term follow‐up results of balloon angioplasty (BA) for patients with native aortic coarctation (AC) on left ventricular hypertrophy (LVH) regression.

The impact of mitral valve morphology on the long-term outcome of mitral balloon valvuloplasty.

Background: The effect of mitral valve morphology (MVM) on the long‐term results of mitral balloon valvuloplasty (MBV) is not well established. The aim of the study was to evaluate the impact of MVM on long‐term outcome of MBV. Methods : Five hundred and eighteen consecutive patients (mean age, 31 ± 11 years) who underwent successful MBV were followed up for 0.5–16.5 (mean, 6 ± 4.5) years. Patients were divided into two groups according to their mitral echo score (MES) before MBV: group A (n = 340; MES ≤ 8) and group B (n = 178; MES > 8). Results: We report the immediate and long‐term clinical and echocardiographic results of the above‐mentioned 518 consecutive patients. The mitral valve area was significantly larger in group A than in group B, both immediately after MBV (2.0 ± 0.3 vs. 1.82 ± 0.3 cm2, respectively; P < 0.0001) and also at the last follow‐up (1.8 ± 0.33 vs. 1.5 ± 0.33 cm2, respectively; P < 0.0001). Restenosis occurred in 38/340 (11%) in group A vs. 73/178 (41%) in group B (P < 0.0001). Actuarial freedom from restenosis at 5, 10, 15 years were 92 ± 2%, 85 ± 3%, 65 ± 6% for group A vs. 72 ± 4%, 44 ± 5%, 9 ± 6% for group B (P < 0.001). Event‐free survival rates at 5, 10, 15 years for group A were 93 ± 1%, 88 ± 2%, 66 ± 6% vs. 82 ± 3%, 59± 6%, 8 ± 7% for group B (P < 0.0001). Stepwise Cox multivariate regression analysis identified MES, preprocedure functional class, and postprocedure mitral valve area ≤ 1.8 cm2, as predictors of restenosis (P < 0.0001, P = 0.014, P = 0.0015, respectively); MES and age as predictors of event‐free survival (P < 0.0001, P < 0.0001, respectively). Conclusion: MBV has excellent long‐term results in patients with favorable MVM. Favourable MVM is a strong predictor of good long‐term outcome.

Favorable effect of balloon mitral valvuloplasty on the incidence of atrial fibrillation in patients with severe mitral stenosis.

Background: The long‐term effect of balloon mitral valvuloplasty (BMV) on the incidence of atrial fibrillation (AF) in patients with severe mitral stenosis (MS) remains undetermined. Aims: To assess the effect of successful BMV on the incidence of chronic AF in patients with severe MS, compare the results with historical controls, and identify factors associated with AF in such patients. Methods: Retrospective analysis of 382 consecutive patients with severe MS and in sinus rhythm (SR) who underwent successful BMV (post procedure mitral valve area (MVA) ≥1.5 cm2, mitral regurgitation (MR) ≤2/4) at our hospital and followed‐up for 1–15.6 (mean 5.6 ± 3.9) years with clinical and echocardiographic examination. Results: Thirty‐four (8.9%) patients developed AF at follow‐up (group A) and 348 patients (group B) remained in SR. At baseline, and in comparison with group B, patients who developed AF (group A) were older, had higher mitral echo score but equal MVA and left atrial (LA) size. The postprocedure MVA was smaller in group A (1.7 ± 0.3 cm2) than in group B (2.0 ± 0.2 cm2; P = 0.002). At follow‐up, and in comparison to group B, group A had smaller MVA (1.5 ± 0.4 cm2 vs 1.8 ± 0.4 cm2 P <0.0001), larger LA dimension (49.4 ± 6.5 vs 42 ± 6.5 mm; P <0.0001) and higher restenosis rate (35% vs 14%; P = 0.001). Multivariate logistic regression analysis identified age at follow‐up (P < 0.0001), LA size at follow‐up (P = 0.004), and MVA at follow‐up (P = 0.006) as predictors of AF. Conclusions: This study demonstrated favorable effect of BMV on the incidence of AF (8.9%) in patients with severe MS in comparison with reported series (29%) of patients with severe MS with similar baseline characteristics who were not submitted to any intervention. The predictors of AF were age, larger LA, and smaller MVA, at follow‐up.

Long-term (up to 18 years) clinical and echocardiographic results of mitral balloon valvuloplasty in 531 consecutive patients and predictors of outcome.

Objectives: The study aim was to assess the long-term results (up to 18 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival. Methods: The immediate and long-term results for 531 consecutive patients (mean age 31 ± 11 years) who underwent successful MBV and were followed up for a mean of 8.5 ± 4.8 years (range: 1.5–18 years) are reported. Results: The mitral valve area (MVA) increased from 0.92 ± 0.17 to 1.95 ± 0.29 cm2 (p < 0.0001). Restenosis was 31 and 19% in patients with mitral echocardiographic score (MES) ≤8. Actuarial freedom from restenosis at 10, 15 and 18 years was 77 ± 2, 46 ± 3 and 18 ± 4% and 86 ± 2, 62 ± 4 and 31 ± 7% for MES ≤8, respectively (p < 0.001). Event-free survival (death, redo MBV, mitral valve replacement, NYHA class III or IV) at 10, 15 and 18 years was 88 ± 1, 53 ± 4, and 21 ± 5% and 93 ± 2, 65 ± 5 and 38 ± 8% for MES ≤8, respectively (p < 0.001). Multivariable Cox regression analysis identified MES >8 (p < 0.0001) and previous surgery (p = 0.043) as predictors of restenosis, and MES >8 (p < 0.0001) and baseline atrial fibrillation (p = 0.03) as predictors of combined events. Conclusion: MBV provides excellent long-term results. The baseline clinical and MES characteristics are predictors of outcome.

Immediate and long-term results of percutaneous mitral balloon valvotomy in asymptomatic or minimally symptomatic patients with severe mitral stenosis

The purpose of this study was to evaluate the safety and value of percutaneous mitral balloon valvotomy (PMBV) in asymptomatic or minimally symptomatic patients with severe mitral stenosis (MS). There are very limited data supporting the concept of PMBV in asymptomatic or minimally symptomatic patients with severe MS. We analyzed the results of 539 consecutive patients with severe MS who underwent PMBV at our hospital. Patients were divided according to their symptoms at the time of PMBV into group A (55 patients), who had few or no symptom (NYHA class 1 or 2), and group B (484 patients), who had severe symptom (NYHA class 3 or 4). Patients had clinical and echocardiographic follow‐up for 0.5–15 years. There was no significant difference in baseline characteristics between the two groups. The immediate mitral valve area (MVA) was equal in both groups. The follow‐up MVA was larger in group A (1.9 ± 0.38 vs. 1.7 ± 0.4 cm2; P = 0.002), and restenosis occurred in 11% in group A vs. 23% in group B (P = 0.023). Actuarial freedoms from restenosis at 5, 10, and 13 years were significantly higher for group A than for group B (97% ± 2%, 77% ± 9%, 77% ± 9% vs. 85% ± 1%, 62% ± 3%, 39% ± 5%; P = 0.0018). Atrial fibrillation at follow‐up was encountered in 11% in group A vs. 20% in group B (P = 0.042). There was a significant reduction of the left atrial size in both groups. Event‐free survivals at 5, 10, and 13 years were higher for group A than for group B (97% ± 2%, 80% ± 9%, 80% ± 9% vs. 86% ± 1%, 65% ± 3%, 42% ± 3%; P = 0.0018). This study demonstrated excellent immediate results of PMBV in asymptomatic or minimally symptomatic patients with severe MS and long‐term results are better compared to the reported natural history of such patients. We recommend mitral balloon valvotomy (MBV) for patients with severe MS with few or no symptoms, provided the valve morphology is suitable for MBV.© 2005 Wiley‐Liss, Inc.

Long-term clinical outcomes of drug-eluting stents in diabetic patients with small vessels compared to larger vessel-7 years clinical follow-up.

OBJECTIVES The aim of this study was to analyze the effectiveness of drug-eluting stents (DES) in small vessels in patients with non-insulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM). BACKGROUND Several randomized trials have shown DES to significantly reduce the angiographic and clinical events in diabetic patients. However, there is insufficient data on similar outcomes in diabetics with small vessels. METHODS We studied 258 consecutive diabetic patients (173 NIDDM and 85 IDDM) who underwent coronary stenting with DES, divided into 2 cohorts: group A (vessels<2.7mm): 163 patients, and group B (vessels≥2.7mm): 95 patients. We analyzed the major adverse cardiac events (MACE) [death, nonfatal myocardial infarction MI, and target lesion revascularization (TVR)] over a mean follow-up of 78.4±14.8months. RESULTS Group A patients had: smaller reference diameter (2.4±0.31 versus 3.14±0.2mm, p=0.0001), longer lesions (19.3±9.5 versus 16.7±7.1mm, p=0.023), more complex lesions: (B2/C) (80.7 versus 52.6%, p<0.033), bifurcation lesions (25.8 versus 11.6%, p=0.007), diffuse disease (42.9 versus 26.3%, p=0.008), multivessel (32.5 versus 18.9%, p=0.019), eccentric lesions (57.1 versus 43.2%, p=0.031), more stents implanted (1.99±1.6 versus 1.7±1.3, p<0.0001), more overlapping stents (29.4 versus 13.7%, p=0.004) and more stents length (25.7±4.9 versus 20.2±2.6, p<0.003). During the follow-up, both groups had overall similar MACE (10.4 versus 11.7%, p=0.9) with insignificant higher restenosis (9.2 versus 8.4%, p=0.832) and TVR (7.4 versus 6.4%, p=0.75) in group A. There was no difference in death (p=0.111) or MI (p=0.858). Both groups had similar stent thrombosis rate (1.2 versus 1.1%, p=0.899), angina events (10.4 versus 16.8%, p=0.137), abnormal stress thallium (14.1 versus 14.7%, p=0.890), and hospital days (2.91 versus 3.57, p=0.886). CONCLUSION Despite complex angiographic characteristics, the use of DES in diabetic patients with small vessels showed favorable clinical outcomes and similar low TVR compared to those with large vessels.