Left Atrium and Mitral Valve Hemodynamics in Patients With Mitral Stenosis Pre and Post‐Percutaneous Balloon Mitral Valvuloplasty: A Systematic Review and Meta‐Analysis

Mitral stenosis (MS) is still a significant cause of cardiovascular morbidity and mortality in low- and middle-income countries, despite being nearly eradicated in the developed world. Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for appropriate patients with MS, but traditional predictors such as mitral valve area and regurgitation grade fail to fully reflect long-term prognosis. This review aims to analyze pre- and post-PBMV hemodynamic changes in the left atrium and determine their prognostic significance in predicting clinical outcomes in patients with MS. This meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251017356). PubMed, Scopus, and Web of Science were searched on March 23, 2025, for studies on adults ≥ 18 years with isolated MS undergoing PBMV. Eligible studies reported both pre- and post-procedure valve and hemodynamic parameters. Primary outcomes included mitral valve area, mean gradient, and left atrial indices. Pooled analyses were conducted in R (v 4.5.1). This meta-analysis included the outcomes of PBMV by comparing pre- and post-procedural data from 30 studies consisting of 2239 participants. Post-PBMV outcomes revealed a significant increase in mitral valve area (MD 0.8834, 95% CI: 0.80; 0.96, p < 0.0001), cardiac output (MD 0.70, 95% CI: 0.58; 0.81, p < 0.0001), and alongside significant reductions in left atrial diameter (MD -4.47; 95% CI: -6.23 to -2.71, p < 0.0001), left atrial pressure (MD -9.51, 95% CI: -11.19; -7.84, p < 0.0001), mitral valve pressure (MD -8.58, 95% CI: -9.41; -7.74, p < 0.0001), and systolic pulmonary pressure (MD -17.96, 95% CI: -21.48; -14.45, p < 0.0001). Out of 2239 patients, 71, 37, and 32 had valve replacement, PBMV repetition, and experienced death, respectively. PBMV showed promising effectiveness and safety in treating patients with MS with a significant increase in cardiac output and MV area and a significant decrease in LA diameter, LA pressure, MV pressure, and systolic pulmonary pressure post-PBMV, while observing low adverse events.