Effects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamics in mitral stenosis: Quantitative assessment by tissue velocity imaging

We hypothesized that mitral annular velocities would improve immediately after relief of mitral stenosis and that serial assessment could be used as an index for quantifying functional changes after percutaneous mitral commissurotomy (PMC). Longitudinal left ventricular annular velocities were quantified by spectral pulsed wave Doppler tissue velocity imaging in 25 patients (16 women; mean age [±SD], 29.2 ± 8.6 years) who had isolated mitral stenosis and were in sinus rhythm, and were compared with 30 age- and sex-matched control subjects. Echocardiography was performed 1 to 24 hours before PMC and 48 to 72 hours after, and changes in velocities from the lateral and septal corners of the mitral annulus in early diastole, late diastole, isovolumic contraction, and ejection were recorded. Systolic and diastolic mitral annular velocities were significantly less in patients with mitral stenosis than in control subjects. After PMC, peak annular velocity of systolic excursion in ejection and peak annular velocity in early diastole showed significant improvement. The change in peak annular velocity in early diastole in the lateral wall correlated well with improvement in the mitral valve orifice area by planimetry (ratio of mitral valve orifice area, 1.92 ± 0.42; ratio of peak annular velocity in early diastole, 1.36 ± 0.22; r = 0.65; P < .001). Serial evaluation of changes in mitral annular velocities by Doppler tissue imaging aids clinical assessment of immediate improvement in left ventricular function after PMC.