Background: One of the ultimate grave consequences of rheumatic heart disease is mitral stenosis. Percutaneous trans-mitral commissurotomy (PTMC) has been practiced with good results in the world since Inoue introduced it in 1982. Objective: The aim of this study was to audit the procedural success, in- hospital outcome in patients undergoing PTMC in our set up. Study Design: Observational cross sectional study. Place and Duration: The study was conducted in northern division of Bangladesh with the collaboration of department of cardiology, Rangpur Medical College Hospital, Rangpur & Zia Heart Foundation, Dinazpur from February 2018 to November 2019. Materials and Methods: Total Thirty patients who fulfill the inclusion and exclusion criteria for PTMC was enrolled in this study. Among them the procedural success & immediate results were assessed. Results: Among 30 patients , 22(73.33%) were female and 8(26.66%) were male showing a female predominance. The mean age was 28.28±8.4.The procedure was successful in 29(96.66%) patients. In 1(3.3%) patient, we failed due to inability to puncture the septum for unfavourable anatomy. There was no mortality related to the procedure, no systemic embolization but one patient (3.33%) had significant MR(G II ). Pre PTMC mean MVA (cm2) was 0.801± 0.1325 and post PTMC it was 1.545± 0.292 cm2. Mean MVPG pre PTMC was 27.108±5.94 mmHg and post PTMC , 6.61±5.008 mmHg with significant p value 0.0001. Mean LA pressure before procedure was 28.65±8.456 mmHg and post PTMC, 11.27±6.34 and p value was 0.0001. Most of the patients 25(83.3%) before PTMC were in severe pulmonary hypertension and after PTMC most of the patients 21(70%) were in mild pulmonary hypertension.We successfully done 7 special cases like pregnancy, re do cases, H/O CVD etc. Conclusions: We conclude that PTMC is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases. University Heart Journal Vol. 17, No. 1, Jan 2021; 47-54
Background: Isovolumic myocardial acceleration (IVA) is a new tissue Doppler parameter in the assessment of systolic function of both right and left ventricles. It remains unaffected with the changes in pre-and after load with in the physiological range. With the advent of newer parameter like IVA, better assessment are naturally expected. Thus it creates a fertile ground where upon many studies are being done as it chosen here. The aim of study was to assess the effect of MS severety on LV systolic function using IVA. Methods: In this cross sectional study, considering all ethical issues, data were collected from 96 patient (Isolated mitral stenosis and mitral valve area <2cm2) and 32 healthy control subjects. In addition to standard echocardiographic methods TDI (tissue Doppler imaging) were performed to assess LV function in all participants. Results: This study showed a clear female preponderence (76%) of mitral stenosis and most of them belonging to age group 21-39 years. All TDI derived LV systolic (IVV, Sm and IVA) velocities were significanty decreased in patients with mitral stenosis, compared to the healthy control (P<.001, for all). However IVA was not different when the degree of MS was evaluated (P=.056). In addition IVA was not correlated with MVA (r=+0.196. P= 0.056). Conclusions: Isovolumic myocardial acceleration was more accurate and consistent than conventional echocardiography in assessing subclinical left ventricular systolic dysfunction, IVA showed that left ventricular function is impaired with mitral stenosis regardless of severety of the disease. So this new echo parameter can be a good supplement to the existing 2D scoring system to detect systolic dysfunction in rheumatic mitral stenosis. University Heart Journal Vol. 17, No. 1, Jan 2021; 42-46
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