Left ventricular filling and ventricular diastolic performance after percutaneous balloon mitral valvotomy

The time course of left ventricular (LV) filling and LV diastolic performance were examined in 27 consecutive patients in sinus rhythm before and acutely after balloon mitral valvotomy (BMV). The mitral valve area acutely increased from 1.1 ± 0.3 to 2.1 ± 0.8 cm². Simultaneous pressure-volume data were obtained using digital subtraction left ventriculography and LV micromanometer pressure before and 10 minutes after BMV. The time constant of LV isovolumic relaxation was unchanged after BMV (50 ± 10 ms before BMV vs 47 ± 13 ms after BMV). In addition, values before and after BMV for LV end-diastolic volume (123 ± 29 vs 125 ± 36 ml), end-diastolic pressure (11 ± 4 vs 12 ± 4 mm Hg) and diastolic filling time (337 ± 126 vs 338 ± 152 ms) were not altered by the procedure. After BMV the peak diastolic filling rate (403 ± 143 vs 469 ± 302 ml/s) was maintained despite a 36% reduction in left atrial filling pressure. There was a trend toward earlier occurrence of the peak filling rate (196 ± 127 vs 146 ± 148 ms, p = 0.08). The percentage of diastolic filling in the first third of diastole, however, was similar (42 ± 9 vs 48 ± 16%) before and after the procedure. Thus, the time course of LV filling is not significantly altered acutely after BMV, but is maintained at reduced left atrial filling pressure. Neither LV relaxation or LV chamber compliance are altered acutely after BMV. Changes in LV diastolic performance, which have recently been shown to alter Doppler mitral valve half-time measurements independent of changes in valve area, do not contribute to the decreased correlation between Doppler and invasive data observed acutely after BMV. In addition, the lack of impairment of LV isovolumic relaxation suggests that LV ischemia or papillary muscle injury are unlikely to contribute to increased mitral regurgitation after BMV.